Bilateral flatfoot before Surgery and  Bilateral flatfoot after Surgery
Ankle Arthroscopy and Subtalar Arthroscopy
Ankle Arthritis in Rhuematoid patient and Ankle Replacement in Rhuematoid Arthritis
Diabetic foot before Surgery and Diabetic foot after Surgery
Claw toe deformity in Rhuematoid patient and Claw toe deformity in Rhuematoid patient after surgery
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Ankle Arthroscopy


Ankle Arthroscopy (Also called minimally invasive surgery or Key hole surgery)

Ankle Arthroscopy involves looking into the Ankle joint using a small (4.5 mm or 2.7 mm diameter) telescope (fibre optic camera) inserted through very small incisions usually less than 1 cm in size. The surgeon can then see the joint on a TV screen in theatre. Specialised hair-pin thickness miniature instruments are then introduced into the joint through another ‘keyhole’ to complete the surgery. Keyhole techniques require a high level of surgical skill, operating in three dimensions, guided by a two dimensional image on screen.

 
Ankle arthroscopy - 2.7 mm scope is used
 
     

Indications

Arthroscopy of ankle is performed for the surgical evaluation and treatment of a variety of ankle conditions. The various disorders in which the technique is useful :

1.
Ankle arthritis
 
2.
Footballers ankle (Anterior Ankle Impingement)
 
3.
Ankle Instability
 
4.
Lateral ligament reconstruction
 
5.
Ankle pain following fracture
 
6.
Loose bodies within the ankle
 
7.
Osteochondral lesion of tibia or talus
 
8.
Diseases of the synovium
 
9.
Undiagnosed ankle pain
 
     

Sports injuries are often repairable with ankle arthroscopy surgery. Cartilage damage can also be repaired through an ankle arthroscopic debridement.

Why Arthroscopy of the ankle is preferred over open surgery?

Because it is minimally invasive, arthroscopy offers many benefits to the patient over traditional surgery. There is no cutting of muscles or tendons. The smaller incisions lead to minimal scarring. This leads to faster recovery and return to regular activities. However, arthroscopy is not appropriate for every patient. Your doctor will discuss the diagnostic and treatment options that are best for you.

Arthroscopic Surgery for Ankle Sprains leading to cartilage damage (osteochondral lesion or OCD)

Arthroscopy of the ankle is often performed for chronic ankle symptoms following a sprain or injury and is usually performed as day case surgery. In fact, injuries to the articular (the portion of the bone that is linked to another bones through an intervening joint of cartilage) surface of the ankle joint are relatively common following ankle sprain and whilst most do not require surgery, those that do, can now be treated with arthroscopic surgery.
A severe sprain may tear the ligaments of the ankle but it can also damage the smooth cartilage covering the joint surface of the bones. This is called an "osteochondral defect" (OCD). Consisting of pieces of cartilage and bone, it may become loose and is a cause of continuing ankle pain following a bad sprain. An arthroscopy may be performed to remove a loose OCD.
In the case of an osteochondral defect, arthroscopy and curretage (clearing and preparing the chipped surface) provide the best chances of recovery, with over 80% of patients reporting complete or significant relief If an intra articular problem is suspected as the cause for the symptoms, then an ankle arthroscopy (keyhole surgery) is indicated.  Overall, ankle arthroscopy in the situation has very good results with the majority of people (more than 75%) having complete or significant relief.

Joint debridgement for arthritis and or anterior bony and soft tissue impingment

Arthroscopy is commonly performed to remove excessive scar tissue and redundant cartilage from the joint. These loose bodies are typically present following an injury or as a result of osteoarthritis, causing significant pain. Occasionally, there may be anterior spurs of bone (osteophytes) at the front of the joint which impinge at the front of the ankle during walking. These can also be removed, along with loose fragments of bone within the joint.

Posterior Ankle Impingment

Posterior ankle impingement syndrome refers to a group of problems that result from pinching of posterior ankle structures by repetitive or acute forced plantar flexion of the foot. Different names have been given to posterior ankle impingement syndrome, including the os trigonum syndrome.
The mechanisms of injury have been likened to a nut in a nutcracker because the posterior talus and surrounding soft tissues are compressed between the tibia and the calcaneus during plantar flexion of the foot.

  Posterior Ankle impingment1   Posterior Ankle impingment2.jpg  
         

This syndrome has been extensively described in classical ballet dancers, but it also has been recognized in individuals who are active in sports. The anatomy of the posterior aspect of the ankle is a key factor in the occurrence of posterior ankle impingement syndrome.
Posterior ankle impingement syndrome may manifest as inflammation of the soft tissues of the posterior ankle, an osseous injury, or both. The osseous injuries include fracture, fragmentation, and pseudoarthrosis of the os trigonum or lateral talar tubercle. As such, posterior ankle and subtalar synovitis as well as flexor hallucis longus tenosynovitis are soft-tissue changes associated with posterior ankle impingement syndrome.
MR imaging is useful in establishing the diagnosis of posterior ankle impingement syndrome.

       
         
         

Whatever the cause, the end result is the same: chronic ankle pain along the back of the ankle (at rest and with palpation), pain with movement, and loss of ankle plantar flexion.
Conservative care with physiotherapy and injections is the first line of treatment. When this is unsuccessful, surgery can done to remove the offending tissue (e.g., bone fragments, scar tissue, thickened joint capsule). In recent years this surgery is now done through a keyhole approach with a much quicker recovery.

Ankle Arthroscopy recovery (foot and ankle keyhole surgery)

1.
You can expect moderate discomfort for a few days
 
2.
You are encouraged to walk on the foot from the day of surgery
 
3.
You will be provided with exercises to begin straight away by the physiotherapist who will see you following surgery
 
4.
Crutches will be provided to assist you in walking initially
 
5.
The bandages can be removed at three days to leave the simple dressings (sticky plaster)which should not be removed until the stitches are removed at 10–14 days
 
6.
The wounds must be kept dry until the stitches are removed – showering /bathing still possible as long as dressings kept dry
 
7.
Return to office work usually possible at one week post surgery but this depends upon the particular demands of your job and your travel arrangements to and from work
 
8.
Driving is usually possible from one to two weeks following surgery, but you must ensure that the ankle is sufficiently comfortable for safe operation of the pedals. You should also inform your insurer before returning to driving. If in doubt wait until you are seen for removal of stitches before returning to driving.
 
9.
You can usually begin to return to sport once the stitches have been removed - gradually increasing your activity as your symptoms improve. Full return to sport would not be expected before six weeks following surgery
 
10.
Some swelling may persist in the ankle for up to three months post surgery although usually this has resolved by six weeks following surgery.