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Brackenhurst, Alberton
011 883 1719 | Rivonia Rd, Hill Rd,
Sandton, 2057
The ankle joint is formed where the foot and the leg meet. The ankle joint is responsible for the up and down movement of the foot.
The foot moves in two basic directions: in and out and up and down. The ankle joint has nothing to do with the in and out movement of the foot, but approximately 75% but not all the up and down movement is from the ankle.
The subtalar joint is below the ankle joint and this contributes to the in and out movement of the ankle.
The subtalar and ankle joint form the hind foot, in front of the hind foot is the midfoot (series of interconnected joints up until the toes) and in front of the midfoot is the forefoot (from the knuckles of all the toes moving forward).
Arthritis is a broad term for a group of conditions involving damage to the joints of the body. Think of a chicken bone with the end capped with the shiny white glistening cartilage. Every joint in the body has this cartilage, and when it wears out, arthritis is present.
Initially there is pain followed by stiffness and with time the pain becomes severe. The most common form of arthritis is known as osteoarthritis and is a result of repetitive minor friction to the joint at a microscopic level where the cartilage cells wear out. Joint problems can also arise from rheumatoid arthritis, gout, ligamentous injuries, trauma to the joint or infection.
Commonly pain may be the initial presenting symptom. Pain is usually well localized, around the specific joint but usually it is deep from within the joint unless there is a deformity resulting in a bony prominence which may interfere with shoe wear and various activities of daily living. There is a great deal of individual variability in the level of symptoms from foot and ankle arthritis rate at and also the which it progresses. Some people have very little pain with advanced arthritis, and others have terrible pain with lesser degrees of arthritis.
Generally, symptoms start with pain and perhaps swelling after prolonged standing or high impact type activity. Once the arthritis advances the frequency of pain and swelling also increases and deformities may present themselves.
In addition to the physical examination, X-rays and laboratory tests often can confirm the type of and extent of the arthritis. Other tests such as a bone scan, computed tomography (CAT) scan, or magnetic resonance imaging (MRI) may be used to evaluate your condition.
Treatment is based upon the level of symptoms and degree of arthritis present.
The requirements and expectations of every patient are taken into consideration, and a decision is made which would best suit your lifestyle and needs.
Treatments may include oral medications such as glucosamine, anti-inflammatory medication, steroid injection, synthetic synovium injection into the joint (Synvisc), and orthotic supports such as pads in your shoes or custom-made braces.
Some of these medications work well to alleviate symptoms, and others such as cortisone injection, have a short effect, but work very well to relieve pain for a few months. Unfortunately, the injections cannot be repeated indefinitely, since they eventually stop working.
There are many types of surgery which can be performed. The decision as to which surgery is best for you is based on bone and joint factors such as the quality of the bone, the severity of the arthritis, the presence of any bone or joint deformity, if the rest of the foot has arthritis or is stiff, and what is the condition of the opposite foot and ankle.
There are also patient factors to take into consideration including your occupation, how much time you spend on your feet, how active your lifestyle is, your exercise interests, your weight, and if you have certain medical conditions such as diabetes which may affect the healing of the surgery.
During our consultation all of the above will be meticulously performed with a definite plan and solution to your ailment to meet your expectations and give you the best quality of life possible.
Arthroscopy may be indicated in the very early stages of treatment only. The procedure involves two or three small punctures in the front of the joint, and a small telescope is inserted into the joint to remove loose fragments of bone, cartilage or extra bone growth spurs and inflamed tissue. If the arthritis is minor or at an early stage, a good response to the arthroscopy treatment is noted in about 80% of patients. Unfortunately, the results of the arthroscopy do not usually last very, and symptoms return necessitating a bigger operation.
Fusion or arthrodesis is the glueing together of two bones. The principle aim of this type of surgery is to relieve pain. Because the ankle joint is responsible for 75% of the up and down movement, with the ankle fused, no further upward movement is present but a limited amount of downward movement still remains after fusion, because of the movement in the joints adjacent to the ankle. This is important particularly for females, because they are still able to wear a heel with an ankle fusion despite the limited ankle movement. The in and out movement of the heel joint is not affected by an ankle fusion.
An ankle fusion is a good operation for certain selected individuals, particularly those with severe bone disease, bone loss or defects in the bone, poor bone quality, and dead bone. Patients who are heavy and who are very active may also be a more suitable candidate for ankle fusion than replacement. With improved techniques the success rates of ankle fusion have increased, and in particular the mini-arthrotomy procedure, a technique pioneered and developed by Dr. Myerson, uses two very small incisions. The success rate of ankle fusion with this technique using tiny incisions should be about 97%. By success we mean that the fusion occurs, and the foot and ankle is in the correct position. Some rare complications following ankle fusion occur early on due to problems with skin healing and some numbness over the top of the ankle. The biggest problem with ankle fusion is the development of arthritis in other joints in the foot many years following the ankle fusion. This is a natural response of the foot joints to the increased stress following the ankle fusion, and some of these patients will require another fusion of these foot joints in the future. When an ankle joint is fused, there is of course no up and down movement in the ankle. There does however remain for some patients a limited amount of up and down movement which occurs in the adjacent joints. The problem is that in later years these joints begin to take the brunt of the force in the foot, and they too begin to develop changes of arthritis. This can be a serious dilemma, since almost 100% of patients will after a prolonged time demonstrate changes of arthritis in these joints next to the ankle on XR. Not all of these patients have symptoms of arthritis, but for some it can be debilitating, since the only option remaining is to fuse these joints as well. What then happens may be a gradual need for further fusion of adjacent joints in the foot, resulting in considerable incapacity.
Exercise is possible following an ankle fusion, and includes walking, hiking, golf, biking, and for some patients skiing and double tennis. There are restrictions noted by all patients because of the stiffness, particularly with activities which require bending movements, including yoga, pilates, crouching and all ball or racquet sports.
The goal of ankle replacement is to maintain or improve the natural movement of the ankle. From a standpoint of day to day activities, there is far better function with an ankle replacement than that of a fusion (where the joints are glued together). The history of ankle replacement when it was first performed in the early 1980’s was not good at all, and was associated with a high rate of failure. This failure was largely due to the incorrect designs of the prosthesis, and the design of the implants has improved considerably over the last 20 years, making ankle replacement a far more realistic operation for surgeons to offer their patients for treatment of ankle arthritis.
The results of ankle replacement today are good, but what do we mean by this statement? The aim of the surgery is to improve or retain the movement in the ankle, and therefore improve the function compared with fusion. However, ankle replacement surgery is complex. A significant learning curve exists and even experienced surgeons have found that it takes time for them to learn how to perform this surgery. It may take many years for a surgeon to gain sufficient experience to perform the surgery and to be able to predictably limit the potential for complications. Recent scientific reports have outlined this problem in more detail, and even though Dr.Nunes has extensive experience with this surgery, complications of surgery still occur.
The main advantage of total ankle replacement is the return of some freedom of movement in the ankle. This movement is important for walking smoothly, exercise and all bending type of activities. Full movement of the ankle joint is never regained even with total ankle replacement. The movement that is present, however, is far preferable to the lack of movement in the fused ankle. There is another very important aspect to ankle replacement in that it avoids the stresses that occur following ankle fusion.
The goal of this type of surgery is to fuse or glue together (arthrodesis) 3 joints of the back of the foot (triple arthrodesis).
It is a very useful operation to correct various types of deformity of the foot as well as certain types of arthritis of the back of the foot.
This type of surgery does not typically affect the up and down movement (dorsiflexion and plantarflexion) of the foot and ankle.
The side to side movement (inversion and eversion) of the back of the foot is affected, and will no longer be present. Usually however for most patients who require the triple arthrodesis, most of this side to side movement has already been lost. The lack of this does not however cause any pain, and all types of exercise are permitted following a triple arthrodesis.
This operation is designed to glue (fuse) the big toe joint together. It is also called an arthrodesis of the big toe or metatarsophalangeal joint (MTP). This is a very commonly performed operation for arthritis and deformity of the big toe (severe bunions) joint and sometimes in conjunction with other toe deformity corrections.
Arthritis of the MTP joint implies that there is no cartilage left and bone on bone grinding is occurring causing swelling, pain and deformity which is not salvageable and the body is in the process of fusing this joint which may take months to years.
The goal of this type of surgery is to fuse or glue together (arthrodesis) one of the joints of the back of the foot.
It is a very useful operation to correct various types of deformity of the foot as well as certain types of arthritis of the back of the foot.
This is a very commonly performed surgery following a break of the heel bone (the calcaneus).
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