Certain foot and ankle conditions may require surgery, especially if conservative treatment options have not been successful.
For example, an Achilles’ tendon tear often requires repair to regain strength in the calf muscle. Tendon or cartilage injuries may also require surgery to remove or repair damaged tissue and keep the ankle from catching or locking.
Some ankle surgeries can be done with an arthroscope, including tendonitis and ankle impingement. An arthroscope causes less harm to healthy tissues and greatly reduces recovery time compared to traditional surgery. Arthroscopic ankle surgery can often address multiple ankle conditions at one time.
Foot and Ankle Surgery
Ankle arthroscopy is an outpatient procedure, which means you arrive at the facility about an hour and a half before your actual surgery time and you do not have to stay overnight in the hospital.
Our staff will check you in and conduct a brief health check, listening to your heart and lungs and checking your blood pressure, pulse, and temperature. We then start an IV for fluids and medications.
The anesthesia staff will discuss your options for medications during surgery. A combination of a general anesthetic and a nerve block is often used; the anesthetic puts you to sleep, while the nerve block numbs your ankle and foot during and after surgery. The nerve block can last up to 24 hours after surgery, and helps manage initial discomfort caused by the surgery. Surgery time can last from one to two hours, depending on how much repair needs to be done in the ankle.
Once you are fast asleep in the operating room, your ankle is filled with saline to help expand the joint, making it easier for your surgeon to move surgical instruments and see tissues.
Your surgeon then makes a small incision and puts an arthroscope into your ankle. This tiny camera is hooked up to a large computer screen and magnifies the structures in your ankle.
Once your surgeon can see in the joint, they insert surgical instruments through another incision and repair damaged tissues. While in your ankle, your surgeon will usually fix any repairable damage they find, even if it was not expected or detected in an MRI.
During an arthroscopy, your surgeon can see exactly what is problematic. A Physician Assistant often helps your surgeon throughout surgery and understands everything that was done.
After surgery, your surgeon will explain what they found and any limitations using your leg. You will be placed on crutches for the first day and will remain on crutches until you regain full sensation in your leg. Before weaning off the crutches, you should be able to bear full weight and walk comfortably.
If more intensive work was done, you may need to use crutches for a few weeks and avoid placing weight on the leg. Usually, your surgeon will ask you to just rest and recover for a few days after surgery. After that, you may take off the bulky surgical dressing and shower. It can be difficult to care for yourself after an ankle arthroscopy, and you may find you need extra help. Your surgeon will be sure to tell your family if you have any specific restrictions after surgery.
In 10 to 14 days, patients can expect to be seen by either their surgeon or a Physician Assistant. At that time, they will discuss what they found during your surgery, what was done, and your recovery process. On average, it takes most patients four to six weeks before they are back to daily activities; however, it can take up to six months to a year before they no longer notice any ankle pain.
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Ankle Arthroscopy Chondroplasty and Debridement
Your ankle joint is where the tibia (shinbone) and fibula (outside lower leg bone) meet your talus bone (ankle). These bony surfaces are covered by smooth, hard cartilage which should ideally be smooth. A hard-cartilage defect or flap can cause your ankle to have a painful catch or click, limiting ankle motion and making it hard to walk, like walking with a rock in your shoe.
A damaged hard-cartilage flap can catch and damage the remaining healthy tissue in your ankle. Relatively small defects can sometimes be polished and smoothed out with gentle motion exercises. For severe damage, surgery may be required to remove the unstable tissue flap.
The ankle joint itself has the potential for soft-tissue fraying or buildup of scar tissue from ankle sprains. This fraying and scar tissue can cause pain, popping, and a feeling of instability and can get flipped up and stuck, causing the ankle to lock. An ankle arthroscopy can smooth out damaged hard cartilage and clean up scar tissue or soft-tissue fraying. Once the problematic area is known, a surgical instrument is used to remove the fraying or flapped hard cartilage and smooth down the remaining tissue. After this procedure, you are often placed on crutches and can wean from them at your own pace. Your surgeon will detail your post-surgery restrictions.
Achilles Tendon Repair
The Achilles tendon connects the calf muscle to the foot and is the thick band on the back side of your ankle. This can become torn with cutting and explosive activities liking jumping or sprinting. Your body relies on this connection to propel yourself forward while walking or jumping – even stepping on the gas pedal while driving.
An Achilles tendon repair is an outpatient procedure that is done with a general anesthetic in conjunction with a nerve block. This provides more initial pain relief after your surgery. Your surgeon will start with an incision on the back side of your ankle and locates the two ends of the tendon. Once they are spotted, your surgeon will use a strong suture to tie the two ends together. Then your surgeon will close the sheath that surrounds your Achilles tendon to help it glide more smoothly. Finally, your incision will be closed up.
After this procedure, you will be placed in a CAM boot and use crutches, not placing any weight on the ankle until you come back for your first post-operative visit. It typically takes at least 6 weeks until you are able to bear full weight on your leg, to allow the tendon to heal without extra stress. Your surgeon will tell your family exactly what your restrictions are after surgery.