Foot and Ankle Orthopedic Surgery
Anatomy of the foot and ankle is exceptionally complex. Your lower extremities are constantly placed under extreme forces, especially compared to other parts of the body, making injury or complications of your foot, ankle or lower leg more likely. In some cases, ailments of the foot and ankle are not successfully treated by conservative, non-surgical options. In these instances, foot or ankle surgery may be the best route. The goal of any surgical procedure is to gain or restore proper function and biomechanics to enable safe, pain free ambulation. Typical foot and ankle pathology which may be amendable to surgery includes congenital and acquired deformities, trauma, or acute and chronic injuries. This is broken down into three anatomical categories.
Foot and Ankle Surgery
Surgery of the forefoot aims at the region from the toes back to the “ball of the foot” and the beginning of the arch. Common procedures include:
- Repair of hammer toes and bunions
- Arthritic joint repair and replacement
- Decompression and excision of neuromas
- Removal of painful bone spurs responsible for corns, and calluses
- Repair of fractures and lacerated tendons
Mid and Rear Foot Surgery
Surgery of the mid and rearfoot includes the region of the foot from the forefoot back and up to the ankle. Common procedures may include:
Treatment of Fractures
Fracture treatment involves the medical management of broken bones to ensure proper healing. This can include:
- Immobilization: Using casts, splints, or braces to keep the fractured bone in place while it heals.
- Closed Reduction: Manipulating the bone externally to align it correctly without surgery.
- Open Reduction and Internal Fixation (ORIF): Surgically aligning the bones and stabilizing them with hardware like plates, screws, or rods.
- External Fixation: Stabilizing the fracture with a frame outside the body that holds the bones in the correct position.
Repair of Ruptured and Lacerated Tendons
Tendon repair addresses injuries where tendons are torn or cut, often requiring surgical intervention:
- Direct Repair: Sewing the torn ends of the tendon back together.
- Tendon Grafting: Using a piece of tendon from another part of the body or a donor to replace the damaged tendon.
- Tendon Transfer: Replacing the damaged tendon with a nearby, functioning tendon to restore movement.
Flatfoot and High Arch Correction
Surgical procedures to correct abnormal foot arches aim to improve function and alleviate pain:
- Flatfoot Correction: Procedures may include osteotomies (cutting and realigning bones), tendon transfers, and the use of implants to support the arch.
- High Arch Correction: Techniques can involve tendon releases, osteotomies, and bone grafts to flatten the arch and improve weight distribution.
Excision of Various Soft Tissue Tumors and Cysts
Removal of benign growths such as fibromas and ganglion cysts:
- Fibroma Excision: Surgical removal of non-cancerous fibrous tissue tumors.
- Ganglion Cyst Excision: Removing fluid-filled cysts that typically develop along tendons or joints.
Plantar Fasciotomies for Treatment of Recalcitrant Plantar Fasciitis
Surgical intervention for chronic plantar fasciitis when conservative treatments fail:
- Plantar Fasciotomy: Cutting part of the plantar fascia ligament to relieve tension and inflammation.
Achilles Tendon Repair
Surgical repair of the Achilles tendon following a rupture or severe injury:
- Tendon Stitching: Sewing the torn ends of the tendon together.
- Grafting: Using a graft to bridge the gap if the tendon ends cannot be directly stitched together.
Resection of Tarsal Coalitions
Surgical treatment for tarsal coalitions, where abnormal connections form between foot bones:
- Resection: Removing the bony, fibrous, or cartilaginous connection to restore normal movement.
Arthritic Joint Resection and Fusion
Procedures to alleviate pain and improve function in arthritic joints:
- Joint Resection: Removing part of the arthritic joint to create a space that fills with scar tissue, relieving pain.
- Joint Fusion (Arthrodesis): Fusing two bones to stabilize the joint and eliminate movement-induced pain.
Decompression of Entrapped Nerves, such as the Tarsal Tunnel
Surgical release of nerves trapped in narrow spaces to relieve pain and restore function:
- Tarsal Tunnel Release: Cutting the ligament that forms the tunnel around the posterior tibial nerve to relieve pressure.
These expanded descriptions provide a comprehensive understanding of each procedure and its purpose.
Ankle Surgery
Ankle surgery is widespread and may be very rewarding for patients. Ankle surgery aims to repair both acute and chronic pathologies of the ankle, and many times, may be combined with procedures performed in the foot. Common procedures may include:
Ankle Fracture Repair
Ankle fracture repair involves the surgical treatment of broken bones in the ankle to restore alignment and function:
- Closed Reduction and Casting: Non-surgical realignment of the bone followed by immobilization in a cast.
- Open Reduction and Internal Fixation (ORIF): Surgical procedure where the bones are repositioned and stabilized with screws, plates, or rods.
- External Fixation: Stabilizing the fracture with an external frame to properly align the bones
Ankle Arthroscopy
Ankle arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems within the ankle joint:
- Diagnostic Arthroscopy: Using a small camera inserted into the joint to visualize the interior structures.
- Therapeutic Arthroscopy: Performing surgical procedures such as removing loose bodies, repairing cartilage, or addressing impingement issues through small incisions with specialized instruments.
Lateral and Medial Ankle Ligament Repair
Repair of the ligaments on the sides of the ankle to address instability or injuries:
- Lateral Ankle Ligament Repair: Reconstructing the ligaments on the outer side of the ankle, often the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), which are commonly injured in sprains.
- Medial Ankle Ligament Repair: Repairing the deltoid ligament on the inner side of the ankle, which may be injured in more severe ankle sprains or fractures.
Treatment of Osteochondral Lesions
Surgical management of damage to the cartilage and underlying bone within the ankle joint:
- Microfracture Surgery: Creating small holes in the bone to stimulate the growth of new cartilage.
- Osteochondral Autograft Transplantation: Transferring healthy cartilage and bone from another part of the joint or body to the damaged area.
- Autologous Chondrocyte Implantation: Culturing and implanting a patient’s cartilage cells to repair the defect.
Ankle Joint Replacement
Total ankle arthroplasty to replace a damaged ankle joint with a prosthesis:
- Total Ankle Replacement (TAR): Removing the damaged portions of the tibia and talus bones and replacing them with a metal and plastic prosthesis to restore joint function and reduce pain from arthritis.
Ankle Joint Fusions
Surgical fusion of the bones in the ankle joint to eliminate pain from arthritis or instability:
- Arthrodesis: Permanently joining the bones of the ankle joint, such as the tibia, fibula, and talus, using screws, plates, or rods, which stabilizes the joint and alleviates pain by eliminating movement.
Ankle Syndesmotic Repair
Surgical treatment of injuries to the syndesmosis, the ligamentous structure that connects the tibia and fibula just above the ankle:
- Syndesmotic Screw Fixation: Using screws to hold the tibia and fibula together while the syndesmosis heals.
- TightRope Fixation: Using a flexible suture device to stabilize the syndesmosis while allowing some natural movement between the bones.
Podiatric Foot and Ankle Surgery
The complex anatomy of the foot and ankle, combined with the extreme forces which are applied upon weight bearing make this area of the body difficult to treat. When conservative, non-surgical measures fail, surgery may be beneficial. It is important to have a trustworthy, well trained foot and ankle surgeon performing your operation.
Surgery is another ideal option to repair an ankle sprain, which is a stretching or tearing of a ligament. An ankle sprain is a common injury and occurs when you fall or suddenly twist the ankle joint or when you land your foot in an awkward position. Sprains can cause pain, swelling, tenderness, bruising, and stiffness, numbness in the toes, and an inability to walk or bear weight on the ankle, resulting in instability of the ankle. Surgical intervention to reconstruct the injured ligament may be considered in patients with a high degree of instability and for those who failed to respond to non-surgical treatments. Consult with a local certified podiatrist at our foot clinics located in South East and South West Florida.