What is Ankle (Arthroscopic And Non-arthroscopic) Surgery?

Ankle arthroscopy is a surgical method used to repair and join the external and internal broken ankle bone, then the doctor strengthens the ankle by making it firm, this procedure is known as ankle reconstruction. Sometimes, the lateral ligament surgery might be done to promote stability too.

We often don’t give much credit to our ankle for helping us to balance the body. When it breaks and pains we realise how important it is, so without further ado, start reading this article to know about surgeries, to keep the ankle intact.

What Is Ankle Arthroscopy?

This procedure diagnoses and treats problems in the ankle joint. During the treatment, your surgeon will make a tiny cut and will place a small camera known as an arthroscope into the ankle that gives them a detailed idea about the internal joint condition. Arthroscopy also diagnoses torn ligaments and reduces the complexity by repairing ligaments and muscles which often becomes stretchy and unsteady. Ankle arthroscopy is a very efficient and fast treatment which gives speedy recovery in comparison to manual methods. Also offers fewer risks and complications and minimum scarring.

ANKLE SURGERY

BEFORE THE ANKLE SURGERY 

• Inform the doctor about your currently ongoing intake of medicines and supplements.
• Stop doing strenuous activities.
• Put an end on blood-thinning and anti-inflammatory medicines such as aspirin, warfarin and ibuprofen.
• Take a halt from eating for at least 7-8 hours.
• Anti-anxiety pills will be prescribed to you a few days before the surgery.

DURING THE SURGERY

• The operation takes 1-2 hours depending on the type of the procedure.
•  The surgeon will give you sedative, general, local or regional anaesthesia.
• The doctor will mark the area of treatment followed by tiny cuts in your ankle, these openings will be a bridge to attach a camera (arthroscope).
• To see clearly, the doctor uses saline or sterile water so that it proliferates and extends.
• The surgeon will then focus on procedure and locates the fault in the ankle, afterwards uses pencil-sized tools to correct the fault.
• Then the camera will be removed and the doctor will sew the cuts and close it.

ANKLE RECOVERY

• You will be discharged on the same day of the surgery and swelling and redness will be seen on the first day.
• Ice cubes diminish the swelling, pain and redness.
• If the need arises, start using crutches or a wheelchair.
• You will be on full bed rest for 4-5 days minimum and so make sure you have someone around you.
• Do follow the exercises which the doctor gives you after some days for a speedy recovery.
• Multiple follow-ups will be required during the recovery phase.

Footballer’s Ankle ( Anterior Ankle Impingement)

When the bone spurs, the ankle starts pinching the front side of the ankle bone and interrupts the movement of the ankle, inflammation and pain start appearing. 

Bone spurs are the soft lumps on the ankle which are extra bony on the edge of the bone.

Mostly happens because of kicking the football, gymnastics, skating, running, dancing while playing cricket, basketball and other ankle stressing activities.

Symptoms Of Footballer’s Ankle

• Unstable leg postures
• Trouble in easy leg movements
• Inflammation
• Unexplained pain and swelling
• Frequent clicking sound in the ankle

Exercises For Anterior Ankle Impingement

1. Stable walk with one leg
2. Rotation of toes
3. Inversion of the ball of the foot with bands
4. Soleus stretches
5. Ankle Plantarflexion

Apart from exercises, starting to wear ankle braces helps in healing the broken ankle.

Ligament Surgery

This surgery is made to tighten multiple ligaments of the outer side of the ankle. Typically for ankle sprains and unsteady lateral ankles. This surgery is outpatient so hospital stays will be less. Earlier and more often ankle sprains can make ligaments unbalanced, infirm and fragile. The objective of the ligament surgery is to put back the stability.

• During the surgery, a doctor gives you general or regional anesthesia and later a cut with J or C shaped is made in the outer part of the ligament and strengthened with anchors.
• Tightly attached ligaments to fibula are anterior talofibular and calcaneofibular ligaments which will be taken out during the procedure.
• When the doctor removes or shortens the ligaments then as a replacement some surgeons use tendons as it fits well and fills the gaps easily. If you get tendons from a donor or cadaver, then surgery will take more time and if it is taken from hamstring then it will take normal time.
• If ligaments are shortened then it is sewed with stitches.

Risk Factors Involved With Lateral Ligament Surgery

• After the effect of anesthesia can be risky
• Nerves or blood vessels can get injured
• Blood clots
• Infection
• Uncontrollable bleeding

Lateral Ligament Recovery

• You will not be allowed to put any kind of pressure on the ankle for 2 months.
• You will be covered with a brace, cotton stockinette, cast or splint.
• You have to wear a walking boot after the surgery then after 1-2 months once the pain lightens you can remove it.
• Complete recovery will be noticed after 5-10 months.

Success Rate Of Ankle Ligament Surgery

It is very successful and very rare cases of unsuccessful surgeries are seen. So about 85-90% of people are satisfied and only 10-15% are not satisfied.

Peroneal Tendon Surgery

Peroneal tendons are powerful, string shaped multiple structures connect the outer layer of the calf to the muscles and surgery is required when these structures get sore. When unbearable tears and dislocation increases immediately a person should be hospitalized.

Tendons are connective tissues that link bone and muscles.

Signs Of Peroneal Tendon Surgery

• Pain at the back of the ankle
• Swelling
• Pain when taking a step ahead

Is Peroneal Surgery Worth It?

Yes, if physical therapies, braces and casts and medicines didn’t work and tendons with surrounded tissues give uneasiness, the only option is surgery and it is very important to nullify the chances of ankle sprains and nerve injury.

What To Expect After Peroneal Tendon Surgery?

• Become totally inactive and avoid moving leg and ankle
• Set in motion and take full rest.
• Fill the form in ultrasound therapy and go 4-5 times in a week.
• For the entire day use a brace and if possible during the night also.

What Is Arthroscopy Debridement Of The Ankle?

This technique is a minimally invasive or keyhole technique which takes out the extra grown bone in the ankle and unuseful cartilage. Only one cut is required for this surgery, as far as I know, and it is done in less time. Most people with arthritis undergo ankle debridement as bone spurs begin to spread in the ankle and cartilage collapses.

Surgery procedure needs general or regional anesthesia and to numb the lower body doctor’s first preference is a spinal block. Then the doctor uses small tools like taps and handles, after marking the surgical area. Later 1-2 more cuts will be made then doctors clean damaged cartilage and bone spur. Then after dressing the doctor will put SAM splints to make the ankle rigid.

After surgery, you will be taken to examine the ankle’s condition and some tests will be done later you can go home but continuous checkups will be required.

Who Are The Good Candidates Of Ankle Arthroscopy Debridement?

• Fractured Ankle
• Twisted ankle
• More bone content
• More cartilage content
• Unbalanced ankle

What Is Ankle Synovitis?

When the joint capsule aligns uniformly with connective tissue, synovium( soft layer) forms. When swelling and inflammation arises in synovial tissues of the ankle bone. The main causes of ankle synovitis of rheumatoid arthritis and osteoarthritis. The natural causes are overpressure in synovial joints and rubbing in athletes, weight lifters, boxers and sportspeople.

Symptoms Of Ankle Synovitis Are :

• An ache in both or either side of the ankle
• Trouble in light and heavy weight lifting
• Soreness

DIAGNOSIS OF ANKLE SYNOVITIS :

• X-ray tests
• MRI scanning
• Ultrasound

FAQs

• How long one can walk after ankle surgery?

One can walk after 1-2 weeks if the pain is less then only and that too for a short distance of about 0.15-0.25 miles.

• Which technique is commonly used to visualize bone fractures?

There are many techniques through which one can visualize bone fractures such as CT scanning, CAT scan, bone scan, stress tests, MRI scan, etc. 

• What is arthrotomy?

When a replacement of the joint is required urgently then a tiny cut is made. Also, it is used to close the gap between the joints. It thoroughly analyses ligaments, sutures and cartilages. Arthrotomy is the traditional method and earlier it was used to cause postoperative complications and risks so nowadays people prefer arthroscopy.

• What is the cost of ankle ligament surgery?

Cost ranges between $3000-$12000, it most probably covers the insurance because it is performed in extremely urgent situations.

• What is the CPT code for arthroscopy?

The CPT code for arthroscopy is 29870.

• What is the difference between laparoscopy and arthroscopy?

LAPAROSCOPY – It is used to diagnose and treat abdomen related organs and those which are near to abdomen.

ARTHROSCOPY – It is used to diagnose and treat defects of joints.

LAPAROSCOPY – Risks are not major such as cough, fever, common cold and nausea.

ARTHROSCOPY – Risks are major such as joint infection, pulmonary embolism and death.

• How long does it take to recover from foot bone spur surgery?

It takes almost 3-4 months to fully recover from foot bone spur surgery.

• Can one put a splint off to shower?

Yes, but the doctor’s advice matters most. While bathing either tie a Ziploc bag or plastic polythene in the surgical area or if it gets a little wet then dry it with a blow dryer.

• Describe the types of ankle surgery.

1. Ankle replacement
2. Lateral Ankle ligament
3. Ankle fusion
4. Tendon surgery
5. Pilon Surgery

• What is Subtalar fusion?

It minimizes the pain caused in the heel region, which is below the ankle. It replaces inborn defects, arthritis, heredity and some crucial injuries and makes it correct.

The procedure is usually done to remove faults which are present in between the heel bone and talus. The recovery process is tedious as it takes 4 months to heal. A doctor recommends the patient to wear a cast boot and brace. Once progress is noticed the patient is advised to do exercises such as bait and towel curls. One can start wearing slippers or flip flops after 5 months of the surgery. Avoid wearing pack shoes.