Foot Surgeons Davenport IA
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Keeping Up With the Latest in Foot and Ankle Surgery
In an effort to help orthopedic surgeons keep up with the latest research, the authors of this specialty update present a summary of evidence related to foot and ankle surgery. More than a dozen of the most common problems are presented including ankle fractures, calcaneal (heel bone) fractures, chronic ankle instability, ankle joint replacement, ankle fusion, diabetes-related problems, tendon problems, bunions, impingement problems, foot deformities, and amputations.
By reviewing all studies published in the last year on foot and ankle surgeries and summarizing presentations made at orthopedic meetings, the information presented hits the high points of what's new. Surgeons reading this summary can then decide if they need to delve deeper into the literature for themselves.
When it comes to trauma resulting in ankle fractures, MRIs and arthroscopy now make it possible to see that the joint surface is often damaged with more severe ankle fractures. Surgeons must be on the look out for lesions of the articular surface of the joint. Sometimes the force is enough to break off bits of cartilage and bone leaving them inside the joint as a loose body. The surgeon must look for, find, and remove these fragments.
Severe ankle fractures may require open reduction and internal fixation (ORIF). An open incision is made; the fracture site is realigned; and metal plates, pins, and/or screws are used to stabilize (hold) everything together. This type of fixation works well with few complications. Problems occur most often in patients with diabetes and poor circulation. Surgeons are advised to keep a close eye on these patients during the post-operative period to prevent infections and the need for amputation.
And a final note on ankle fractures in particular. Surgeons often debate the need to cast or immobilize the ankle after surgery versus having the patient move the ankle early in order to keep joint mobile. So far, it looks like early motion is better but has some risks. Early motion helps prevent blood clots but seems to increase the risk of wound infection. The surgeon should strive for early mobility but make the decision based on each patient's individual characteristics and risk factors.
As for calcaneal (heel bone) fractures, there's enough evidence now to show that these patients end up with painful arthritis and foot deformities. Can these be prevented? Are they the result of the type of treatment (surgery vs. nonoperative care) provided in the first place? All evidence points to a better end-result when open reduction and internal fixation (ORIF) is later followed by fusion of the joint.
Efforts are being made to place screws percutaneously (through the skin without an open incision) for the fixation of calcaneal fractures. Using titanium screws instead of metal plates seems to work well and reduces the risk of wound infection.
Severe ankle pain following repeated ankle sprains or caused by traumatic arthritis that ...