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Foot and Ankle Treatment Options
Treatment options presented by your physician can vary; inclusive of medications, natural treatments, physical therapy or possibly surgery might be discussed. Be sure to talk to your doctor to find the right treatment option for you.
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Soft Tissue Reattachment1
Common in sports related injuries, this procedure involves the end of a tendon or soft tissue being reattached to another bone or tendon. It is often used when a muscle group has become weak, torn, or paralyzed.
When conservative methods of relieving pain or deformities in the ankle are unsuccessful, a surgical procedure called ankle fusion (arthrodesis) is sometimes considered.
Multiple techniques are used in this procedure, and the intended results are relief from pain and regained stability. If successful, an ankle fusion is not in danger of wearing out like an artificial ankle.
In primary ankle fusion surgery, the ankle joint is surgically accessed and prepared, allowing the tibia (shinbone) to grow together, or fuse, with the talus bone (the first large bone of the foot). Pins, plates, screws or rods often are inserted through the bones to hold the bones together until they heal. More severe clinical indications may warrant fusing other joints, including the subtalar joint. Though the procedure results in the loss of some movement of the foot and ankle joints, it can be very effective in reducing pain, correcting deformities and stabilizing the joints.
The basic goal of fracture fixation is to stabilize the fractured bone, to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity. Fractures can be treated conservatively or with external and internal fixation.
Conservative fracture treatment consists of closed reduction to restore the bone alignment. Subsequent stabilization is then achieved with traction or external splinting by slings, splints, or casts. Braces are used to limit range of motion of a joint.
External fixators provide fracture fixation based on the principle of splinting. There are three basic types of external fixators:
- Standard uniplanar fixator
- Ring fixator
- Hybrid fixator
The numerous devices used for internal fixation are roughly divided into a few major categories:
- Pins and screws
- Intramedullary nails or rods
Staples and clamps are also used occasionally for osteotomy or fracture fixation. Autogenous bone grafts, allografts, and bone graft substitutes are frequently used for the treatment of bone defects of various causes. For infected fractures as well as for treatment of bone infections, antibiotic beads are frequently used.
Total ankle replacement removes and then replaces both sides of the ankle joint with specially designed components, called prostheses. The tibial prosthesis consists of a polyethylene (medical grade plastic) and titanium base plate tray that is inserted into the tibia and fibula, giving the implant a wide base for support.
Each artificial ankle prosthesis is made up of two parts:
- The tibial component is the metal portion of the joint replacement that replaces the socket of the ankle (the top portion).
- The talus component replaces the top of the talus. The talus is the first bone of the foot and sits in the mortise of the ankle.
The upper portion of the talus, the bone that moves up and down, is replaced with a component made of cobalt chromium alloy, a metal commonly used in joint replacement prostheses. The tibial component is usually made up of two parts, a metal tray that is attached directly to the bone and a plastic cup that provides the bearing surface. The plastic used is very tough and very slick.
Bone graft is then placed between fibula and the tibia to create a fusion between the two bones. This stops the motion between the two bones that could loosen the joint replacement. The bone graft is taken from the bone that has been removed from the ankle earlier.
Then the ankle is tested to make sure the pieces fit properly. To make sure that the ankle socket or the mortise component fits tightly, two screws are placed between the fibula and the tibia just above the ankle joint. When the surgeon decides that everything is satisfactory, the ankle joint capsule is sutured back together and the skin is sutured together. A large bandage and splint are placed on the lower leg to protect the new ankle joint as your leg heals.
1. Lu HH, Thomopoulos S. Functional attachment of soft tissues to bone: development, healing, and tissue engineering. Annu Rev Biomed Eng. 2013;15:201-226.
2. Honnenahalli Chandrappa M, Hajibandeh S, Hajibandeh S. Ankle arthrodesis-Open versus arthroscopic: A systematic review and meta-analysis. J Clin Orthop Trauma. 2017;8(Suppl 2):S71-s77.
3. Deleu PA, Besse JL, Naaim A, et al. Change in gait biomechanics after total ankle replacement and ankle arthrodesis: a systematic review and meta-analysis. Clin Biomech (Bristol, Avon). 2020;73:213-225.
4. Taljanovic MS, Jones MD, Ruth JT, Benjamin JB, Sheppard JE, Hunter TB. Fracture Fixation. RadioGraphics. 2003;23(6):1569-1590.