Posts for tag: Ankle Surgery

You may have read Dr. Coker’s blog in October regarding post-traumatic arthritis and noticed she mentioned the idea that joints can be fused or sometimes replaced. You may even have had a knee or hip replacement already and were wondering if your ankle may need something too, as it no longer works like it used to.

Yes, we do replace ankles, just like knees and hips are replaced. However, not everyone walking through the door with arthritis in their ankle is a good candidate for an ankle replacement. First of all, an ankle replacement needs to be done by an experienced and certified foot and ankle surgeon, as the procedure is technically demanding. One must be qualified, capable, and willing to deal with any and all potential complications. Secondly, all patients considering an ankle replacement must be thoroughly educated on the risks and benefits of the procedure as well as the post-operative recovery. They must also understand the alternatives as well in order to make a well informed decision. Lastly, it never hurts to obtain a second opinion if you do not feel adequately informed about the procedure.

With that said, what makes a patient a good candidate for an ankle replacement? There are numerous criteria, some of which are more important than others. When considering a total ankle replacement, the assumption is that you have attempted conservative measures such as bracing, nonsteroidal anti-inflammatory medication, injections and shoe gear modifications. The criteria for an ankle replacement is obviously not a systematic checklist of indications as every case and patient must be considered individually in light of their physical and social situation. However, with that said there are some basic indications that are considered with each patient.

An ideal candidate for a total ankle replacement (TAR) is an individual who is less than 250 pounds, over 50 years old, has no hindfoot deformity, has a lower physical demand, and has severe pain secondary to ankle arthritis. Relative contraindications to a TAR is a high activity level (determined between you and your surgeon), weight greater than 250 pounds, bone loss, osteoporosis, and a history of infection. A patient with diabetes and a history of Charcot Neuroarthropathy, or with an ongoing infection or ulceration should never be considered for an ankle replacement.

A careful look at the literature comparing ankle arthrodesis, or fusion, to a total ankle replacement, shows that the early and intermediate-term outcomes of the two procedures are comparable. Individuals with a fusion tend to have a worse functional outcome due to the restricted motion, whereas, those with a replacement have a higher rate of complications. One study in 2001, noted that 67% of patients with an ankle fusion were happy with their results after 20 years. In comparison, a study in 2007 reviewed 531 total ankle replacements and found a 76% 10-year survival rate. This was confirmed in a 2009 study that found a 75% 10-year survival rate of total ankle replacements.

Both an ankle fusion and ankle replacement has its risks and benefits and it is important, that if determined to be a candidate for either procedure, that you understand the potential risks and the long term effects. Ankle replacements have come a long way and can be a very gratifying and beneficial procedure but it certainly is not for everyone. However, if you are suffering from ankle arthritis it is a procedure to discuss with your foot and ankle specialist to determine if it is a procedure for you. 

By Dr. Tarick Abdo
January 31, 2013
Category: Sports Injury

While lateral ankle sprains are the most common athletic injury occurring in sports, high ankle sprains have been responsible for more lost time from game play and training activities. Unfortunately, high ankle sprains are commonly mistaken for lateral ankle sprains, thus they are less commonly reported. 

Misdiagnosing a high ankle sprain can result in lingering pain and recovery as the treatment course is much longer, requiring longer periods of offloading and rehabilitation in comparison to lateral ankle sprains. 

A high ankle sprain refers to injury of the ligaments that join the lower leg bones, tibia and fibula. High ankle sprain injuries commonly occur in collision sports, such as football, hockey, and court sports  such as basketball. The most common mechanism of injury is when the foot is anchored to the ground while being struck to the outside aspect of the lower leg. This forceful twisting injury may be accompanied by an audible pop and the patient’s inability to bear weight after the injury.  

On examination, patients often present with swelling and bruising above the ankle. The most commonly utilized test is the fibular squeeze test which can produce pain at the lower ankle by squeezing the outside and inside aspect of the leg at the middle of the leg.  In addition, your doctor can move the lower leg inward and this can elicit severe pain. At this stage, your doctor will order an x-ray the classic finding is widening of the tibia and fibula at the level of the ankle.  If the x-ray is inconclusive then a MRI scan provides the best confirmation of widening of the lower leg and identify specific syndesmotic ligaments that are disrupted. Treatment is then determined based on the degree of separation and the ligaments that are involved.

In some case where the degree of separation is severe usually greater than 4mm than surgical intervention is necessary to achieve anatomic reduction and can improve functional outcomes and facilitate a quicker return to activity. Without this intervention, patients can have long term pain and instability and develop post traumatic arthritis. Patients with less than 4mm of separation can be managed conservatively with immobilization for 1 week then placement in a double upright hinged ankle brace, known as a Velocity Brace this begins the next phase of rehabilitation. Then range of motion exercises are implemented with low intensity resistance and high repetition.  Gait training and light balance exercises may begin at the patient’s tolerance. The last phase of rehabilitation begins once a patient is able to hop on the injured foot without any pain. Patients then begin more active range of motion and change of direction exercises and can shortly return to full sports activity. 

The key to quick recovery from high ankle sprains is quick diagnosis by an experienced clinician. Then appropriate treatment based on the degree of instability. Most patients make a full recovery and have  no limitations once they return to activity. Hopefully this gives you some insight into this injury.    

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