Arthroscopy – A Minimally Invasive Surgical Approach in Treating Ankle Pathology

Persistent ankle pain can limit activity and disrupt the ability to comfortably carry out the most simple activities of daily living. The severity of symptoms can vary from individual to individual. Causes for generalized ankle pain and impingement can include 1) joint damage, 2) damage to the ankle joint capsule and 3) ligament and tendon damage.

These painful conditions can be acutely initiated following an injury as basic as twisting an ankle. Other factors that can contribute to bone, soft tissue and joint damage include generalized repetitive motions over a long period of time which can weaken anatomic structures resulting in overuse syndromes. In some cases, these conditions can be treated conservatively with a combination of injections, physical therapy, bracing/orthotics and anti inflammatory medications. Surgery, however, is often indicated and can prove very effective in treating certain ankle conditions.

Ankle pathology such as torn ligaments, joint cartilage damage, ankle joint capsule synovitis and loose floating pieces of cartilage/bone can all be treated via arthroscopic surgery. These conditions, typically identified through physical examination and MRI, can cause ankle joint impingement, limitation of ankle joint motion as well as joint pain with activity. In addition, many patients note clicking and popping sounds audibly recognized as emanating from the joint itself.

Surgical techniques typically fall into one of two major categories – traditional open procedures vs. minimally invasive techniques. Ankle arthroscopy is a surgical procedure which is minimally invasive and provides the surgeon access to the interior of the joint in order to repair physical damage to the affected structures. The technique is traditionally performed via two very small incisions at the anterior aspect of the ankle which allows for the introduction of a small camera or ‘scope’ and specialized instruments into the joint space. The live arthroscopic images are viewed during surgery on a television monitor in real time.

Through this arthroscopic technique regions of cartilage damage can be removed and micro fractured to encourage new tissue growth. Torn ligaments can also be debrided and repaired. Synovitis, as well, can be resected along with the removal of bone spurs and loose floating pieces of bone and cartilage found in the joint.

Post operative recovery can range from 7 – 21 days depending upon the underlying pathology addressed. In many cases physical therapy and active range of motion exercises are prescribed. In some instances patients are encouraged to begin waking within 24 hours of surgery. The limited incision size reduces recovery and provides the added benefit of limited scar tissue formation in comparison to more traditional surgical approaches. The majority of patients report an improvement in joint function and mobility following the procedure.

By |2018-10-01T23:28:46-05:00May 17th, 2015|

Listen to Your Feet

As the colder weather forces us to wear closed toe shoes, the problems that were ignored over the spring and summer are now becoming vastly apparent. Painful lumps and bumps are now more than just a nuisance. They actually start to limit our daily activities especially during this very busy time of year. I would like to discuss some of the most common foot and ankle problems that usually arise in the winter time and tend to be more aggravated by shoe wear.

The first problem to discuss is ingrown toenails. Unfortunately, patients usually do not seek treatment until the ingrown toenail becomes infected. The best treatment at this point is to remove the infected portion of the toenail. This is done through a five minute procedure in the office under a local anesthetic. There is typically very little if any pain after the procedure.

Bunions and hammertoes also become greatly more symptomatic with closed toe shoe gear. Bunions are essentially a progressive dislocation of your big toe joint and as the big toe starts to drift toward your second toe a large bump on the inside of the big toe joint becomes more problematic with footwear and movement.

Hammertoes are essentially progressive dislocations of bones and joints of each toe. The toe starts to contract and then the toe essentially sits higher and rubs on the inside portion of the shoe. We typically see this affecting the second and fifth toe. There are no sure fire conservative measures to fix these problems but there are many over the counter splints, pads and shoe wear modifications that can be applied to help reduce some of the discomfort caused by bunions and hammertoes. Purchasing a shoe with a wide square toe box can be beneficial. Custom made orthotics can also help reduce pressure to these symptomatic areas. The best treatment for bunions and hammertoes still remains to have the deformities fixed surgically through an outpatient procedure.

Neuromas are another common problem affected by closed toe shoes. The nerve supplying feeling to the toe becomes inflamed and irritated. Most people describe a feeling like walking on a rock or pebble or possibly their sock is wadded up in the shoe. Neuromas can be further irritated by pointed toe shoes or high heels. Obviously, footwear modifications are of great help but most of the time patients have waited too long for shoe gear modifications to be of great help. At this point, non-steroidal anti-inflammatory drugs (NSAID) and trigger point injections of local anesthetic combined with steroid are very helpful. In fact, these methods produce complete resolution of symptoms for the vast majority patients.

Haglund’s Deformity, or spurring to the back of the heel bone, also becomes very problematic this time of year with boots and shoes. These spurs can produce considerable pain during the first few steps following rest. Irritation from shoe wear can also cause irritation. X-rays are generally required to ensure that the spur did not crack or break off. People do very well with NSAID’s, heel lifts and physical therapy. If this course of treatment does not help an MRI is warranted to ensure that the Achilles tendon does not have a partial tear. Unfortunately, many times the spur is the ultimate problem and needs to be removed but conservative therapy can be very helpful as well.

The most important thing to realize is that foot and/or ankle pain is not normal and should be evaluated by a podiatrist sooner rather than later. More often than not patients wait because they think the pain will go away. Our feet are the foundation of our very busy, mobile lifestyles and the better we treat our feet the easier it will be to go through the year pain free.

By |2018-10-01T23:28:46-05:00April 29th, 2015|