Chronic Ankle Pain

Ankle pain can arise from a number of different causes.  Most commonly, either (a) a history of one or more severe sprains which never completely healed or (b) "wear and tear" of the ankle as a result of years of poor alignment or biomechanics of the foot leads to chronic pain in the ankle.  Pain can be present upon taking your first steps in the morning, or on damp, rainy days.  Pain can worsen with increased activity.  In any event, pain in the foot or ankle is NEVER normal! 

Often, physical therapy, cortisone injections or oral anti-inflammatory medication can alleviate this condition, which is usually caused by a swelling or enlargement of the lining of the inside of the joint, called the synovium.  Synovitis is the term used to describe this condition.  In addition to synovitis, sometimes there is damage to the ankle joint cartilage, or even a loose fragment of bone which can be lodged within the joint, causing pain when the ankle joint moves through its range of motion.

In the cases where these conservative treatments fail to alleviate the chronic painful symptoms, ankle arthroscopy is a wonderful minimally invasive technique used to evaluate and treat these conditions.

Arthroscopy of the Foot and Ankle

Technology and unique instrumentation have led to the development of surgical techniques for the diagnosis and repair of joint disorders. Knee arthroscopy was developed in the late 1960's. Small joint arthroscopy was developed in the early 1980's by orthopaedic and podiatric surgeons and adapted to foot and ankle joints.

Your podiatric surgeon may identify a potential problem with a foot or ankle joint after examining the lower extremity. Arthroscopic surgery may be recommended to confirm a diagnosis or perform a surgical procedure within a joint using an arthroscopic instrument. For example, needle-like probes enter the joint through a small opening of the skin. The podiatric surgeon introduces a tiny camera to inspect the joint. The podiatric surgeon may also insert surgical instruments through another small incision to perform additional procedures within the joint.

Unlike traditional joint surgery that requires large incisions to expose the joint, arthroscopy uses small openings to examine the joint. By eliminating the need for large incisions, arthroscopy reduces the risk of infection and swelling. Podiatric surgeons may perform arthroscopic surgery in hospitals, outpatient surgery centers and in their offices. Arthroscopy is often a "same day" procedure allowing the patient to return home after surgery. Your podiatric surgeon will discuss all aspects of surgery with you.

Instrumentation

Podiatric surgeons use delicate instruments and miniature video cameras to perform arthroscopic surgery. These instruments include cutting tools, burrs, graspers, shavers, fastening tools, sutures, laser and electrocautery to control bleeding.

Arthoscopic techniques allow for a variety of procedures that are performed on foot and ankle joints. The following table reflects conditions for which the arthoscope can be used to diagnose and perform reconstructive procedures.

Condition

Arthroscopic Treatment

chronic ankle pain

diagnosis, biopsy

arthritis

biopsy, arthroplasty, fusion

loose bodies

excision

ankle instability (the feeling of giving way)

ligament repair

cartilage fractures, chondromalacia

cartilage repair or removal

meniscoid body (scar tissue)

excision, biopsy

Advantages of arthroscopic surgery include reduced trauma due to the small instruments used. Small instruments cause less damage to surrounding skin, ligaments, tendons and bony structures. Movement of the joint reduces swelling, stiffness, and postoperative discomfort. Your podiatric surgeon may recommend exercising the joint to hasten your recovery to bathing, walking, and sports activity.

Postoperative Care

Your podiatric surgeon may recommend rest, ice, compression, and elevation ("RICE") to help speed healing.

REST

Ask your podiatric surgeon how long you should rest or restrict activity.

ICE

Ice reduces swelling, bleeding and pain following surgery.

COMPRESSION

Dressings help reduce swelling and stabilize the joint, preventing unnecessary motion. Dressings should be snug but should not interfere with proper circulation.

ELEVATION

Keep the foot at or above the level of your heart to drain excess fluids away from your foot. This helps to reduce swelling and discomfort.

Summary

Arthroscopy allows your podiatric surgeon to look directly into your ankle and reach a more accurate diagnosis. Additional benefits of arthroscopy include a shortened postoperative course and rapid recovery.

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2001   The American College of Foot and Ankle Surgeons
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