Minimally Invasive Surgery | Foot and Ankle Pain | The Relief Institute

Minimally Invasive Surgery

Ankle arthroscopy is a minimally invasive surgical technique that utilizes the technology of fiberoptics. In minimally invasive surgery, our listed doctors use a variety of techniques to operate with less damage to the body than with open surgery. In general, minimally invasive surgery is associated with less pain, a shorter hospital stay and fewer complications.

While endoscopy describes any surgery done through one or more small incisions, ankle arthroscopy is a minimally invasive surgical technique focused on the joints. This treatment utilizes the technology of fiberoptics, magnifying lenses, and digital video monitors to visualize the inside of your ankle through small incisions. Several incisions are made about your ankle to allow for the insertion of an arthroscope, or small fiberoptic video camera, and/or special arthroscopic instruments. Sterile fluid is also circulated through your ankle to distend the joint, creating more space for the arthroscope and instruments. This allows better visibility within your ankle, space to maneuver instruments, and clearance of debris.

Ankle arthroscopy can sometimes be used as an alternative to open ankle surgery, which is a surgical approach utilizing larger incisions to access the inside of the ankle. It can be used to diagnose and treat different disorders of the ankle joint.

Conditions

The list of problems that this technology can be used for is constantly evolving.

Common conditions include:

  • Osteochondral defect of the talus (also referred to as osteochondritis dessicans, OCDs, osteochondral fractures). This includes acute ankle sprains and repetitive Ankle Injury caused by chronic instability. Patients will often present with complaints of persistent and progressive ankle pain and swelling.
  • Anterior Ankle Impingement (also referred to as “athlete’s ankle” or “footballer’s ankle”) and Anterolateral Ankle Impingement. These occur when either bone and soft tissue of the anterior (the “front”) ankle joint becomes inflamed due to repetitive stress or irritation. This will cause pain in the ankle joint, swelling, and can limit the motion of the ankle, especially dorsiflexion (loss of the ability to bend your “toes towards your nose”). Walking uphill is often painful. This is common in soccer players and any athlete with recurrent ankle sprains.
  • Posterior Ankle Impingement. This occurs when the bone and soft tissue of the hindfoot (the “back” of the ankle) becomes inflamed due to repetitive stress. This will cause pain in the ankle joint, swelling, and often times limited motion of the ankle, especially plantarflexion (loss of the ability to “press on the gas”). This overuse syndrome occurs most commonly in ballet dancers, but can also be seen in other athletes.
  • Synovitis. Synovitis is inflammation of the soft tissue lining of the ankle joint (synovium) that will often manifest as pain, swelling, and loss of motion. This can occur due to an acute trauma, inflammatory arthritis (i.e. rheumatoid arthritis), overuse, and degenerative joint disease (osteoarthritis).
  • Loose Bodies. Articular cartilage and/or scar tissue following trauma to the ankle can become free-floating in the joint and form what is referred to as a “loose body”. These can also occur within the setting of a condition called synovial chondromatosis, where the lining of the joint becomes redundant for unexplained reasons. These loose bodies can cause problems such as clicking, catching, and frank locking that often lead to pain, swelling, and loss of Motion.
  • Arthrofibrosis. Sometimes, previous trauma, prior ankle surgery, infections of the ankle joint, and inflammatory arthritides, such as rheumatoid arthritis, predispose patients to the development of scar tissue, or arthrofibrosis.
  • Infection. Septic arthritis, or infection of the joint space, cannot be treated effectively with antibiotics alone. It often necessitates an urgent surgery to wash out the joint. The decision of whether or not an infection is amenable to arthroscopic surgery is determined by many factors.
  • Ankle Fractures. Ankle arthroscopy can also be used along with conventional techniques of fracture repair to ensure that normal anatomic alignment of cartilage within the ankle is restored.
  • Unexplained Ankle Symptoms. Occasionally patients develop symptoms, such as pain, swelling, locking, catching, grinding, or popping, that cannot be explained with diagnostic techniques such as X-rays, CT scans, MRIs, or bone scans.
  • Tibiotalar Arthritis. Ankle fractures, infection, osteonecrosis, and arthritis may eventually lead to chronic pain and stiffness that can not be controlled with nonoperative measures.

Ankle Injury
Usually due to an underlying injury, ankle pain refers to any kind of sudden or worsening discomfort affecting any part of the ankle.

Arthritis of the Foot and Ankle
The pain and stiffness you feel in your feet and ankles as you age could be arthritis. If left untreated, this nagging pain can get worse over time, eventually making it difficult to walk even short distances.

Bent Toe Disorders (Hammer, Mallet and Claw)
A bent toe disorder is an oddly bent toe joint. Hammer, claw and mallet toes are often painful and commonly occur in one or more of the four smaller toes.

Big Toe Arthritis (Hallux Rigidus)
Hallux rigidus is arthritis of the joint at the base of the big toe.

Bone Union Problem
A bone is “healed” when it is strong enough to allow for normal activities. A bone union problem is a bone that does not heal properly or is taking longer than expected.

Broken Ankle (Ankle Fracture)
A fracture is a partial or complete break in a bone.

Bunion
A bunion is a visible, bony bump that forms at the joint of the toe. It occurs when some of the bones in the front part of the foot move out of place.

Cavus Foot
Cavus foot is a condition in which the foot has a very high arch. This can lead to a variety of other symptoms and can develop at any age.

Great Big Toe Joint Disorder
Hallux rigidus is a disorder of the joint located at the base of the great big toe. It causes pain and stiffness in the joint.

Haglund’s Deformity
Haglund’s deformity is a bony enlargement on the back of the heel that, when it rubs against shoes, may irritate the soft tissues near the Achilles tendon.

Impingement
Ankle Impingement is a condition where pain is experienced due to compression of the bony or soft tissue structures during a specific range of motion.

Injuries to the Achilles Tendon
An overly stressed Achilles tendon can be subject to mild or serious injuries. If the injury is mild or moderate, it may be limited to burning or stiffness.

Instability
Instability is the inability of a joint to support weight or maintain balance, a feat which requires coordination between functional ligaments and tendons.

Ligament Sprain
An ankle sprain is an injury to a ligament, a band of tissue that functions like a rubber band to connect bones and bind joints together.

Morton’s Neuroma
Morton’s neuroma is a painful condition that affects the ball of the foot, most commonly the area between the third and fourth toes.

Osteochondral Lesions
Osteochondral lesions of the talus (OLT), sometimes called osteochondritis dessicans or osteochondral fractures, are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone itself as well as cartilage that overlays it.

Sesamoid Injury
A sesamoid acts as a pulley to help a tendon flex and curl. A sesamoid injury affects the bone’s ability to provide leverage while walking and jumping.

Surgery

Ankle arthroscopy is generally performed as an outpatient surgery under general anesthesia with or without a regional pain block or epidural anesthetic with sedation.

  • After adequate anesthesia is established, a tourniquet is applied to your leg, and the leg is prepped and draped in a sterile fashion.
  • Mechanical distraction devices are sometimes used to help temporarily enlarge the potential space of your ankle.
  • After your foot and ankle are appropriately positioned, your doctor will make at least two approximately 0.5mm incisions in your ankle. These incisions become the entry sites into your ankle for an arthroscopic camera and other instruments. The incisions can be made in the front and back of your ankle.
  • Sterile fluid is then allowed to flow through your ankle to further open the joint.
  • The camera and instruments can then be exchanged between portals to perform the surgery.
  • At the conclusion of the procedure, small sutures are placed in the skin to close the portals.
  • Then your doctor will apply a sterile compressive dressing, and sometimes a splint or boot
  • You will then be brought to the recovery area and are usually discharged home the same day with specific weight-bearing and dressing care instructions.

 

Rehabilitation

Your recovery depends on the type of problem and nature of the arthroscopic procedure used to treat your problem. You can expect pain and swelling following surgery that necessitates elevation of the leg and oral pain medication for at least several days. The type of procedure performed will determine whether or not your ability to bear weight on your affected leg will be restricted after surgery. This can range from progressive immediate weight-bearing with crutches, to a period of strict non-weight-bearing for one to two months. If ankle arthroscopy is used as an adjunct to conventional fracture fixation, this period of non-weight-bearing may be longer depending on your body’s ability to heal the fracture. Your dressing will be left in place until your follow-up meeting, and your doctor will remove the sutures one to two weeks after surgery. Active range of motion is generally allowed immediately. After the swelling and soft tissue reaction subsides, your doctor may implement a progressive strengthening routine. Based on the evaluation, your doctor will determine when each of these activities is allowed and whether or not a formal physical therapy referral is necessary.

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