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Lateral ligament reconstruction for chronic ankle instability
After an acute or repeated ankle sprain the ligaments may be torn and the ability to walk on uneven surfaces becomes limited. We call this chronic instability of the ankle and repeated ‘going over’ on the ankle increases the risk of other problems such as bruising of the cartilage and bone spurs, which can lead to ankle arthritis.
A physiotherapist led ankle strengthening program maybe all that is required to treat this, but if this fails to stop the ankle ‘going over’ then a surgical repair in specialist hands that tightens up the loose ankle ligaments (Brostrum) can be performed. This allows individuals to return to all forms of athletic activity without risk of recurrent injury to the ankle.
Bunions come in all shapes and sizes causing significant variation in symptoms. If a bunion does not cause pain or crowd the second toe then surgery is generally not necessary. If surgery is indicated, the technique varies with the degree of deformity. For mild deformities, a simple shaving of the bony prominence may suffice but for more advanced deformities the metatarsal bone will need to be broken and reset to narrow the forefoot. The cut bone is held in place with small screws that can stay in the patient. The pain after surgery is minimised by special nerve block techniques and patients are allowed to bear weight on their heel in a special surgical sandal.
Cheilectomy for big toe arthritis
Arthritis of the big toe may present with pain which is worse with motion, stiffness or bony hard lumps on the top of the toe that get sore when the shoe rubs on them. The initial treatment is non-operative comprising of anti-inflammatory medication, stiffer soled and wide shoes. Surgery is indicted in patients who remain persistently symptomatic. Cheilectomy is performed for milder cases and entails shaving the spur that forms on top of the joint. This eliminates pressure caused by the spurs and often improves joint motion. After this surgery patients can walk from day one.
Fusion for big toe arthritis
When no good cartilage is left, we fuse the joint by preparing the bone in such a way that the body is tricked into thinking the bones are broken and so it bridges them eliminating the arthritic joint and relieving the pain. Buried metal screws hold the bones while this process occurs after which patients are left with a stiff but pain free toe. They can resume sporting activities and do not walk with a limp. Joint replacement of the big toe is possible but there is no evidence that they work in the long run.
This is ‘keyhole surgery’ done through two or three 4 mm incisions allowing direct visualisation with a small camera of problems that may not have even shown up on an x-ray or a scan and special small instruments allow us to treat the problem once it is identified. For some people, arthroscopy means a speedier recovery, less scarring, and fewer complications than open surgery. An ankle arthroscopy is carried for pain, clicking or if there is a build-up of excessive scar tissue and bone spurs at the front of the ankle that can cause pain and restrict movement. Patients have a short anaesthetic and usually go home on the same day with crutches and resume normal activities at 3 to 6 weeks.
Achilles tendon rupture
This serious condition typically occurs in activities where there is a sudden push off such as Basketball, Squash or Badminton especially in less conditioned athletes. It can be managed either with plaster if it presents fresh or surgery. The healing times are the same. Surgery entails bringing the separated tendon ends together and resting it in a plaster and later a boot while the healing process takes place. Surgical repair is associated with a lower chance of re-rupture.
Mild cases can be managed by clearing debris and bone spurs using ankle arthroscopy. If there is no good cartilage left then the most proven treatment is an ankle fusion. We fuse the ankle by preparing the bone in such a way that the body is tricked into thinking the bones are broken and so it bridges them eliminating the arthritic joint and relieving the pain. Buried metal screws hold the tibia and talus while this process occurs after which patients are left with a stiff but pain free ankle. In selected patients, ankle replacement is also an option.
A nerve that lies between the toes, typically in the 3rd webspace may be squashed or damaged. As a result it becomes inflamed and enlarged. Anywhere else in the body, this would not pose a great problem but in the foot we keep walking on this painful nerve, squashing it with each step causing considerable pain and numbness. In cases that have not settled with simple treatments, surgery to release or excise the nerve is a relatively simple procedure that can treat this often very painful condition.