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 the damaged tissue and prevent 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. Often times, multiple ankle conditions can be addressed at one time with arthroscopic ankle surgery.
Foot and Ankle Surgery
Ankle arthroscopy is an outpatient procedure, which means you do not have to stay overnight in the hospital. For this procedure, you will arrive at the facility about an hour and a half before your actual surgery time. Our staff will check you in and conduct a brief health check by listening to your heart and lungs and checking your blood pressure, pulse, and temperature. We will then start an IV to give you fluids and medications. The anesthesia staff will discuss your options for medications during surgery. Often times, a general anesthetic will be used in conjunction with a nerve block; the anesthetic will put you to sleep and the nerve block will numb your ankle and foot both during and after the surgery. The nerve block can last up to 24 hours after surgery, which helps to manage the initial discomfort caused by the surgery. Your surgery time can vary depending on how much repair needs to be done in the ankle, but can last anywhere from one to two hours.
Once you are fast asleep in the operating room, your ankle gets filled with saline. Saline helps expand your joint, making it easier for your surgeon to move surgical instruments and better see tissues. To be able to see inside of your joint, your surgeon puts an arthroscope into your ankle, which is a tiny camera hooked up to a large computer screen. This magnifies the structures in your ankle and allows your surgeon to view it with their own eyes.
Once your surgeon can see in the joint, they make another incision to insert their surgical instruments and are able to repair the damaged tissue. While in your ankle, your surgeon will usually fix any repairable damage they find, even if it was not expected before surgery. Even MRIs can miss damage in your ankle, but 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 during your surgery.
After surgery, your surgeon will explain what they found in the operating room to your family and discuss any limitations you will have using your leg. You will be placed on crutches for the first day and 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 any weight on the leg. Usually, your surgeon will ask you to just rest and recover for a few days after surgery. After those few days, you may take off the bulky dressing from surgery and are allowed to shower. As you can imagine, 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.
Patients can expect to be seen by either their surgeon or a Physician Assistant in 10-14 days. At that time, they will discuss with you 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 their 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 the area which the tibia (shinbone) and fibula (outside lower leg bone) meet your talus bone (ankle). These bony surfaces are covered by hard cartilage which should ideally be smooth. If there is a defect or flap in the hard cartilage it can cause your ankle to have a painful catch or click. This can limit the motion of your ankle and make it hard to walk, like walking with a rock in your shoe. A damaged hard cartilage flap can catch and cause damage to the remaining healthy tissue in your ankle. If the defect is relatively small, it can sometimes be polished and smoothed out with gentle motion exercises. If the hard cartilage damage is severe, surgical intervention may be required to remove the unstable flap of tissue. 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 arthroscopic procedure 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 begin to wean from them as you tolerate. Your surgeon will tell your family exactly what your restrictions are after surgery.
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 help it glide more smoothly. Finally, your incision will be close 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.