Overview
The ankle is an important bone-joint in the body and is critical for healthy, overall movement of a human being. Like with any other bone-joint or part of the body, the ankle too is vulnerable to injury or degradation due to various reasons. In such a case, corrective surgery may be required to restore healthy functionality of the ankle. In this article, we will examine such corrective surgeries.
Introduction
The ankle is the joint where the leg meets the foot. It is an important part of the body, as the entire weight of the person has to be borne or supported by the ankle. Further, it plays an important role in various types of movement. Sitting, standing, walking, running, stretching legs, jumping, and various exercises – all involve the ankle and its ability to flex, bend or move as desired.
Structure of the Ankle
The ankle is responsible for the up and down movement of the foot. The ankle-joint is where 3 bones meet:
- The tibia or the shin bone, which is the long and thick bone which forms the bulk of the lower leg (from the knee to the foot)
- The fibula which is a thinner bone that runs parallel to the tibia and adjacent to it
- The talus or the foot bone which sits atop the heel bone
The surface of all the bones at the ankle-joint are covered with articular cartilage. Further, there are many ligaments, which are tough, moving and connective tissue that surround the ankle-joint, binding the tibia and fibula to each other and to the talus. These ligaments are what help us walk, stand, run, jump and perform various exercises, day-in and day-out.
Challenges in Ankle Health
Like with any other bone-joint in the body, the ankle too can suffer from overuse trauma or overuse injury. Other than this, there are various conditions that affect the health and performance of the ankle-joint. These can affect the mobility or stability of the ankle-joint along with causing pain and deformity of the ankle-joint.
- Sprained ankle: This is one of the most common ankle issues. One can accidentally twist or turn a foot, causing damage to one or more ligaments in the ankle. Treatment will involve prevention of pain, swelling and any long-term damage.
- High ankle sprain: The high ankle is the vertical portion of the ankle-joint where the leg meets the foot, while the horizontal portion is called the true ankle. Where the two bones of the leg (tibia and fibula) meet, there is a ligament joining the two called as syndesmotic ligament. Injury to this ligament can cause pain and swelling similar to that of true-ankle sprain, but this takes longer to heal.
- Ankle fracture: Accidents and sports injuries can cause one of the three bones at the ankle joint to break. Most often, the tibia or fibula is fractured.
- Arthritis of the ankle: Although rare, some people can develop osteoarthritis in the ankle, along with other parts of the body.
- Rheumatoid arthritis: An autoimmune disorder in which the body’s immune system attacks joint-tissue treating it as an alien matter. This leads to, pain, inflammation and swelling at the ankle-joint.
- Gout: When excess uric acid is produced in the body, these crystals start depositing in bone-joints including the ankle. The condition is called gout, and causes severe pain and swelling in the ankle.
- Psoriatic arthritis: Psoriasis is a skin condition and causes arthritis in bone joints such as the ankle. Symptoms include pain and swelling.
- Septic arthritis: Bacterial infections at the ankle-joint can trigger this form of arthritis which causes severe pain, swelling, fever and difficulty in moving the ankle.
- Chronic tendonitis of the ankle: As the name implies, tendonitis is a condition in which one or more tendons in any part of the body develop inflammation. When it happens at the ankle-joint, it causes pain and swelling.
- Chronic synovitis of the ankle: Also called Ankle Joint Effusion, this is marked by inflammation of the synovium (a gel-like, connective tissue) at the ankle. Excess fluid leaks into the joint which blocks out nutrients to surrounding tissues. There is degradation of the cartilage, swelling of the membrane, excess pressure on the surface of the joint and over time – instability of the joint.
Treatment Options
In the initial days of the condition, the doctors (qualified orthopaedics or podiatrists) will try various options such as
- RICE therapy: ‘Rest, Ice, Compression and Elevation’ is the first course of treatment for ankle injuries.
- Over-the-counter pain-killers: Such as ibuprofen, acetaminophen and naproxen.
- Cortisone injections to the ankle: These suppresses inflammation in the ankle joint, reducing pain and swelling. Usually given for some forms of ankle arthritis.
- Ankle immobilization: A cast is put around the ankle to immobilize it temporarily. Its highly preferred in case of ankle fractures, and severe cases of ankle sprains too.
When none of the above work, ankle surgery may be inevitable. There are various types of ankle surgeries. These may be minimally-invasive or incisional, requiring general or local anaesthesia. Recovery time will also depend on the type of surgery, and will require the person to use special crutches, boots or casts.
Types of Ankle Surgery
- Ankle arthroscopy: A minimally-invasive procedure, this is undertaken for arthritis and injuries of the ankle. In this, the doctors make multiple and tiny incisions at the ankle. Then, using endoscopic instruments, pieces of damaged bone or cartilage from the ankle are removed.
- Tendon surgery: In case of chronic tendonitis or synovitis of the ankle, the diseased tendon tissue is either taken out or repaired. In case of Achilles repair/reconstruction and tendon transfer, the diseased tendon is removed and another tendon from the foot is transferred here instead.
- Ankle fracture surgery: Fractured bones in the ankle are stabilized or held in place using metal plates, screws and small metal wires to accelerate the healing. Again, depending on the type of fracture, there are different types of fracture surgery done.
- Ankle fusion: This is done to treat arthritis of the ankle. In this procedure, the surgeons will remove tissue from the surfaces of the ankle joint that are damaged or affected by arthritis. Then, they will fuse or join all the ankle bones together permanently, using metal plates and screws. Permanent ankle fusion will limit the movement of the ankle joint thereafter, but is the best approach in some cases of ankle arthritis.
- Ankle replacement: Similar to knee-cap or hip replacement surgeries. In this, doctors will remove the damaged ankle joint, and replace with a joint made of plastic or metal. In many cases, the replacement joint is attached to the existing ankle-joint using a special surgical glue. Then using screws, the ankle replacement is stabilized.
- Brostrom procedure or lateral ankle ligament reconstruction. This is the best approach for chronic instability of the ankle caused by deformities in the foot. In this, the surgeons will make a small incision on the outside of the ankle. Then using special techniques, they will tighten up the loose and weakened ligaments which are causing the instability in the ankle.
Risks from Ankle Surgery
Ankle surgery can cause complications in some people and these include:
- Deep vein thrombosis: DVT is marked by bleeding and blood clots in the veins of the legs.
- Some nerves or blood vessels in the ankle may get damaged
- Infection, which is common with any surgery
- Weakness or stiffness of the ankle joint that lasts long
- Extreme reactions to anaesthesia, which can happen with any surgery
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