Certain foot and ankle conditions may require surgery, especially if conservative treatment options haven’t 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
Before your surgery is even scheduled you will meet with your orthopedic surgeon to talk over the surgical procedure, its risks and benefits, and your questions or concerns.
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 don’t have to stay overnight in the hospital.
Our staff will check you in, have you change into a surgical gown, 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, and prep the surgery site.
The anesthesia staff will meet with you and review your health history, past surgeries, and current medications, and discuss your anesthesia options.
A combination of a general anesthetic (to put you to sleep) and a nerve block (to numb your ankle and foot during and after surgery) is often used. The nerve block can last up to 24 hours after surgery, and helps manage initial discomfort caused by the surgery. Surgery can last from one to two hours, depending on how much repair needs to be done.
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 in your ankle and inserts an arthroscope, a tiny camera connected to a large computer screen that 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 unexpected or undetected by an MRI.
During an arthroscopy, your surgeon can see exactly what is problematic. A Physician Assistant (PA) often helps your surgeon throughout surgery and understands everything that was done.
After surgery, your surgeon will tell you and your family what they found and any limitations you’ll have using your leg. You’ll be placed on crutches the first day and will remain on crutches until you regain full sensation in your leg. Before weaning off 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 can take off the bulky surgical dressing and shower.
It can be hard to care for yourself after an ankle arthroscopy, and you may find you need extra help. Don’t be afraid to ask for help if you need it.
In 10 to 14 days, patients will meet with either their surgeon or a PA to discuss your surgery, what was found, and your recovery process. 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. A hard-cartilage defect can damage the remaining healthy tissue in your ankle and cause a painful catch or click, limiting ankle motion and making it hard to walk, like walking with a rock in your shoe.
Relatively small defects can sometimes be polished and smoothed with gentle motion exercises, though surgery may be required for severe damage.
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. It can also get flipped up and stuck, causing the ankle to lock.
An ankle arthroscopy can smooth damaged hard cartilage and clean up scar tissue or soft-tissue fraying. 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, the thick band on the back side of your ankle, connects the calf muscle to the foot. Your body relies on this connection to propel yourself forward while walking or jumping – even stepping on the gas pedal while driving. This can tear with cutting and explosive activities liking jumping or sprinting.
An Achilles-tendon repair is an outpatient procedure done with a general anesthetic (to put you to sleep) in conjunction with a nerve block (to provide more initial pain relief after surgery). Your surgeon makes an incision on the back side of your ankle, locates the two ends of the tendon, and uses a strong suture to tie the two ends together. Then your surgeon closes the sheath that surrounds your Achilles tendon to help it glide more smoothly, and closes the incision.
After this procedure, you’re placed in a CAM boot and on 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 can 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.