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Surgery of Hindfoot and Ankle Deformities
Hindfoot and ankle deformity may result in
decreased activity levels, inability to maintain meaningful employment,
inability to walk or difficulty getting through activities of daily
living. These severe deformities are often the result of previous
trauma, congenital birth defects, acquired from degenerative changes
throughout the course of oneﾒs adult life or may be secondary to
systemic disease. Diseases such as diabetes mellitus, rheumatoid
arthritis and various types of neuromuscular conditions may result in
severe foot and ankle deformity. The deformities ultimately result in
pain and difficulty walking. Non-operative therapy including orthotics, injection therapy,
anti-inflammatory medications, bracing, etc. are the first lines of
treatment to provide comfort and maintain activities of daily living.
However, certain deformities may fail to respond to non-operative care.
Surgery can eliminate the deformity, decrease pain and increase
activity level. Surgery is the ultimate solution to restore a
relatively normal functioning foot that will permit a person to get
through activities of daily living or maintaining meaningful employment. Surgical Intervention Surgery
often consists of arthrodesis (fusion) procedures that permit a
realignment of the existing deformity. The ultimate goal is to
reconstruct the bony architecture of the foot so that the foot may be
placed into appropriate footgear or bracing so that a patient can walk
without pain. The exact surgery depends on the specific nature of the
deformity. Realignment arthrodesis often requires a 1-2 night stay in
the hospital. These procedures are performed under general inhalation
anesthesia. Various types of internal and external fixation devices are
often required either temporarily or permanently to maintain the foot
or ankle in the appropriate alignment during the healing process. Recovery Time The
postoperative convalescence includes three months in a
non-weight-bearing short leg cast. This is followed by protected
weight-bearing in a rocker bottom brace for an additional 2-3 months.
The patient is then ultimately placed in custom molded or extra depth
shoe with an appropriate orthotic or a permanent brace. Possible Complications Complications
include infection, nonunion (failure of bones to heal together),
fixation problems and malalignment (failure of realignment to be
maintained). Additionally, stress fractures of the tibia (long leg
bone) have been reported. These complications are managed by early
recognition and prompt intervention. These complex procedures often
require revisonal surgery to address complications. Summary Realignment
arthrodesis of the hindfoot and ankle can be a very gratifying
procedure. The ultimate goal is to have a patient who can walk without
pain. Although surgery does provide realignment, some type of support
in the form of an orthotic or brace is often required. The
postoperative convalescence is quite extensive and the patient and
their families should have a thorough consultation by the surgeon. It
may take 6-12 months for a patient to get back to pre-surgical activity
levels. A surgeon who is thoroughly experienced in hindfoot and ankle
surgery should perform these procedures. The surgeon performing these
types of procedures should have specialized continuing medical
education, special postgraduate training and extensive experience with
hindfoot and ankle surgery.
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