Surgery on the foot, ankle, or lower leg is usually performed by podiatric surgeons and orthopedic surgeons specializing in the foot and ankle.
Surgery on the foot, ankle, or lower leg is usually performed by podiatric surgeons and orthopedic surgeons specializing in the foot and ankle.
External fixation is a surgical treatment used to stabilize bone and soft tissues at a distance from the operative or injury focus. They provide unobstructed access to the relevant skeletal and soft tissue structures for their initial assessment and also for secondary interventions needed to restore bony continuity and a functional soft tissue cover.
Treats the following conditions:
Treats the following conditions:
What are the goals of TAR?
The goal of TAR is to improve ankle motion so the patient has less pain during activity.
What signs indicate TAR may be needed?
TAR is considered in patients that experience ankle pain and decreased function from arthritis after trying conservative management. Conservative management includes anti-inflammatory medication, bracing, physical therapy, activity modification and pain medication. Patients with rheumatoid arthritis are usually good candidates for the ankle joint replacement. Other patients that should be considered are those that need but do not want a fusion-type procedure that would eliminate the motion at the ankle joint.
When should I avoid a TAR?
TAR is not suited for patients with significant deformity or dead bone in the talus, which is the bottom bone of the ankle joint. Prior or current infections of the ankle, significant lower extremity neuropathy, inadequate or absent leg muscle function, poor blood flow of the leg, or inadequate soft tissues are also signs that TAA should be avoided.
General Details of Procedure
TAR is performed either under general anesthetic or nerve block. A tourniquet is used at the time of surgery to control bleeding and improve visualization during the surgery. The ankle is approached from the front or the side depending on the type of implant being used. Bone is then cut, allowing for placement of the metal and plastic components that re-create the ankle joint. Sometimes the patient will have a tight calf muscle or tight Achilles tendon that needs to be lengthened to improve range of motion of the ankle. The wounds are then closed using stitches or staples, and a splint is applied. A period of non-weightbearing in either a cast or cast boot is necessary to allow the implants to heal in place.
Specific Technique
Either before or after the ankle replacement is put in place, the orthopaedic foot and ankle surgeon will determine if the calf muscle or Achilles is tight. A tight calf muscle or Achilles tendon is addressed with a lengthening procedure. This is important to improve motion after the surgery, as well as to take stress off the ankle replacement.
What happens after surgery?
Recovery from a total ankle replacement requires a period of non-weightbearing and immobilization. The procedure is usually
Post-surgery X-ray of an ankle replacement
performed in an inpatient setting, with the patient spending one to several nights in the hospital. Strict elevation for many days after the procedure is necessary to control swelling and improve wound healing. After the surgical wounds are healed, some orthopaedic foot and ankle surgeons will allow the patient to start working on gentle range-of-motion activities even if they are non-weightbearing. Weightbearing usually begins a few weeks after surgery if X-rays show good healing.
Potential Complications
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Fracture of bone on either side of the total ankle implant is the most common complication. Injury to tendons or nerves and blood vessels is also a possible complication of ankle replacement. Wound healing can be a problem in patients that smoke or have diabetes, or in patients that have rheumatoid arthritis. Another complication that is sometimes seen is the failure of the ankle implant to heal into the bone.
Treats the following conditions:
What are the goals of lateral ankle stabilization?
Ankle sprains are one of the most common sports-related injuries. They affect 10,000 people per day. When the ligaments on the outside of the ankle are stretched or torn, patients can have pain and feelings of instability. If symptoms persist after non-surgical treatment, surgery may be required. So the goal of lateral ankle stabilization surgery is to repair the injured ligaments.
What signs indicate surgery may be needed?
Patients that have failed physical therapy and bracing and have instability of the ankle may consider surgery.
When should I avoid surgery?
Patients should not have this surgery if they have certain medical issues or poor circulation or are unable to follow the recommended post-surgery rehab. You should discuss any medical concerns with your surgeon.
General Details of Procedures
The torn ends of the ligaments are identified. If possible, they are repaired by sewing the ends together. Commonly, the ligaments are reconnected to the fibula bone. Other tissues may be used to strengthen the repair.
Specific Technique
A general anesthetic is commonly used. Patients may have a nerve block to numb the leg along with sedative medicines given through an IV. An incision is made on the outside of the ankle over the torn ligaments. The ligaments are identified and, if possible, sewn together with stitches. Sometimes the ligaments are not strong enough on their own, and other tissue is moved from the top the foot and “tightened” to strengthen the repair. Typically tissue is re-attached to the fibula bone with stitches placed through holes drilled in the bone or with anchors placed into the bone. The incision is closed. A splint or cast is often placed. Patients typically go home the same day.
What happens after surgery?
After surgery, casting may be used for two to six weeks. Patients then go into a walking boot or brace and begin physical therapy. It is recommended that patients wear a brace for sports activities for up to a year.
Potential Complications
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Nerve injury can sometimes occur after ligament repair. This can result in numbness or burning on the outside of the foot. Wound complications and stiffness can also occur. Recurrent ankle instability may occur.
Treats the following conditions:
Arthroscopic surgery on the foot and ankle may be used as a diagnostic or treatment procedure, or both. A small instrument, called an arthroscope, penetrates the skin through small incisions.Tiny cameras can be inserted through the arthroscope, allowing the surgeon to accurately see the area and/or damage. Other small instruments can also be inserted through the arthroscope to make surgical corrections.
Because arthroscopy is less-invasive and traumatic than traditional surgery, it reduces the risk of infection and swelling, and allows for significantly speedier healing and recovery. Most arthroscopic surgeries of the foot and ankle are performed on a same-day, outpatient basis using a local anesthetic.
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Adult-acquired flatfoot or posterior tibial tendon dysfunction usually leads to a gradual loss of the arch. The posterior tibial muscle is a deep muscle in the back of the calf and has a long tendon that extends from above the ankle and attaches into several sites around the arch of the foot. The muscle acts like a stirrup on the inside of the foot to help support the arch. The posterior tibial muscle stabilizes the arch and creates a rigid platform for walking and running. If the posterior tibial tendon becomes damaged or tears, the arch loses its stability and as a result, collapses, causing a flatfoot.
Surgery is often performed to give the patient a more functional and stable foot. Several procedures may be required to correct a flatfoot deformity, depending on the severity of the problem. These may include:
Bunions are progressive bone deformities of the foot that often cause recurring or chronic inflammation, irritation, and pain that require surgical correction. Surgical removal of a bunion is called a bunionectomy. However, there are multiple types of bunionectomies, each designed to resolve different structural changes caused by the deformity.
Bunion surgeries fall into two major categories:
There are three important factors that impact the success of bunion surgery:
What To Expect
Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.
Prior to the surgery, patients will need to make some preparatory arrangements. These include:
The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.
Bunion surgery is usually performed with a local anesthetic and is administered by an anesthesiologist. This may be combined with sedation medication to put you into “twilight” so that you are fully relaxed. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.
The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the sutures are removed.
During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.
Sutures are generally removed about two weeks after the surgery in the doctor’s office. Once the sutures are removed, you can bathe and shower normally, but will still need to wear a dressing over the wound to keep it clean and prevent infection.
By the third or fourth week post surgery, swelling generally subsides enough for the patient to begin wearing a wide athletic shoe. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lotions to soften the skin in the surgical area.
By week five after the surgery, you will be able to walk short distances and do mild fitness activities. Continue following your surgeons instructions for increasing exercise and activities until you are back to normal.
Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and painful, requiring surgery.
Hammertoe surgery can be done on an outpatient basis in the doctor’s office or a surgery center using a local anesthetic, sometimes combined with sedation. The surgery takes about 15 minutes to perform. Up to four small incisions are made and the tendons are rebalanced around the toe so that it no longer curls. Patients usually can walk immediately after the surgery wearing a special surgical shoe. Minimal or no pain medication is needed following the surgery.
Icing and elevation of the foot is recommended during the first week following the procedure to prevent excessive swelling and promote healing. It is also important that the dressing be kept clean and dry to prevent infection. Two weeks after the surgery, the sutures are removed and a wide athletic shoe can replace the post-operative surgical shoe. Patients can then gradually increase their walking and other physical activities.
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
What are tendon transfers?
Some tendon transfers allow the ankle and foot to move up and down and regain some motion. Others bring the foot into a position where it is easier to walk, stand and wear shoes, but will not increase range of motion.
What are the goals of a tendon transfer?
What signs indicate a tendon transfer may be needed?
When should I avoid surgery?
There are three requirements for tendon transfers to be successful. First, the muscle that the tendon is attached to has to be functional. It must contract at the proper time during walking to do what it needs to do. Second, the soft tissue through which the tendon is to be transferred needs to be as normal as possible. Large areas of scarring or skin damage can make it difficult to transfer the tendon. It can also prevent the tendon from gliding along the path it must travel in order to function as planned. And third, the joints that the tendon crosses need to be both mobile and stable.
General Details of Procedure
What happens after surgery?
Patients are typically non-weight bearing for six weeks after surgery to allow the transferred tendon to heal to its new attachment. This can be longer or shorter depending on what is seen during surgery. After six weeks, patients usually start to bear more weight on the leg and are placed in a boot if they aren’t in one already. Patients are out of the cast or boot by 12 weeks after surgery.Physical therapy is usually needed to regain the strength of the transferred muscle and to help the patient learn to walk more normally. The transferred muscle is weaker than it was in its original functional position because of the transfer. There may be some limitations in motion of the foot due to the tendon transfer, but the function regained by the transfer should outweigh the function lost.
Potential Complications
Sometimes the tendon transfer does not heal into its new position. The implant could break or loosen, or there could be progression of the original neurologic condition needing further surgery.
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Surgery to repair a torn (ruptured) Achilles tendon is conducted on an outpatient basis using a local anesthetic. It involves making an incision or cut in the back of the leg above the heel to access the torn tendon. The tendon is then sewn back together. Surgery may be delayed for about one week after the rupture to let the swelling go down.
After surgery, a cast or walking boot is usually worn for six to 12 weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down).
Specific gentle exercises (restricted motion) after surgery can shorten the time needed in rehabilitation.
Treats the following conditions:
Surgery to repair a torn (ruptured) Achilles tendon is conducted on an outpatient basis using a local anesthetic. It involves making an incision or cut in the back of the leg above the heel to access the torn tendon. The tendon is then sewn back together. Surgery may be delayed for about one week after the rupture to let the swelling go down.
After surgery, a cast or walking boot is usually worn for six to 12 weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down).
Specific gentle exercises (restricted motion) after surgery can shorten the time needed in rehabilitation.
Treats the following conditions:
Many conditions can affect the rear part of the foot and ankle. Two common conditions can cause pain to the bottom of the heel and lead to surgical intervention: plantar fasciitis (an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes) and heel spurs (often the result of stress on the muscles and fascia of the foot).
There are many causes of heel pain and most cases can be effectively treated without surgery. Chronic heel pain, however, often can be corrected only through surgery.
A surgical procedure, called an osteotomy, is performed to relieve the pressure on the bone from heel calluses. The procedure involves cutting the metatarsal bone in a “V” shape, lifting the bone and aligning it with the other bones. This alleviates the pressure and prevents formation of a heel callus.
Treats the following conditions:
Midfoot fusion is a procedure in which the separate bones that make up the arch of the foot are fused into a single mass of bone. Fusion is also referred to as arthrodesis. Fusion eliminates the normal motion that occurs between two bones.
Midfoot fusion can involve all of the midfoot joints. More commonly just one or a few of the joints are fused. The joints of the midfoot do not bend and move like your knee or elbow. They are designed to be relatively stiff to give your foot strength and support your body. Midfoot fusion does not generally produce much noticeable loss of motion because there is fairly little motion to begin with.
Treats the following conditions:
Hindfoot fusion is considered to relieve severe pain from arthritis or to correct a foot deformity, such as clubfoot or grow defects due to conditions such as Spina Bifida. The number of joints fused depends upon the severity of the arthritis or defect of the foot.
Treats the following conditions:
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