Archives des Foot & Ankle - Dr Majed Issa https://drmajedissa.com/en/category/foot-ankle-en/ Chirurgien Orthopédique et Traumatologue Thu, 08 Feb 2024 13:54:19 +0000 en-GB hourly 1 https://wordpress.org/?v=6.9.4 https://drmajedissa.com/wp-content/uploads/2021/10/cropped-Logo-docteur-majed-issa-bleu-e1690128320683-32x32.png Archives des Foot & Ankle - Dr Majed Issa https://drmajedissa.com/en/category/foot-ankle-en/ 32 32 CLAW TOES https://drmajedissa.com/en/claw-toes/ Mon, 05 Feb 2024 20:04:22 +0000 https://drmajedissa.com/?p=9246 Toe clawing refers to deformities of the lateral toes, either in the horizontal and/or vertical planes. These toe claw deformities can lead to abnormal weight-bearing on the ground or in footwear, creating painful areas of hyper-pressure (“corns” or “calluses”). We will not detail here the deformities of the hallux (1st toe or “big toe”) but only those of the adjacent toes (from the 2nd to the 5th toes). ANATOMY : Toe or “toe fingers” constitute the termination of the forefoot. They serve a function in walking, as well as in balance and posture. The lateral toes are composed of a bony skeleton of 3 phalanges (proximal, middle, and distal phalanx) extending from the bony skeleton of the metatarsals. There are thus 3 articulations: The metatarsophalangeal joint (MTP) between the metatarsal and the proximal phalanx; The proximal interphalangeal joint (PIP) between the proximal and middle phalanges; The distal interphalangeal joint (DIP) between the middle and distal phalanges. These articulations are held together by a fibrous system allowing the mobilization of the two bony pieces relative to each other (“the joint capsule”), reinforced laterally by ligaments. At its lower (plantar) part, the joint is reinforced by a thicker structure allowing it to resist pressure, the “plantar plate”. The movement of these articulations is ensured by extensor and flexor tendons, respectively serving to extend and flex the toes. These tendons insert on the phalanges, the flexors on the underside, and the extensors on the upper side. The distal phalanx carries the nail on its upper (dorsal) part and the pulp on its lower surface (plantar part). The toes possess numerous and important nerve endings, originating from 2 digital nerves (1 on each side of the toe), dividing into multiple microscopic nerve fibers ensuring sensitivity. This rich innervation explains the significant pain present in the pathology of these toes. THE PATHOLOGY : In the normal state, the toes are aligned next to each other, with contact on the ground at the pulp level. Their mobility is more limited than that of the hands but still allows for some lifting or flexion movements on the ground. Toe claws encompass any deformity of the toes in the horizontal and/or vertical plane. These deformities result from disorders of bone orientation, tendon retractions, or joint abnormalities. These deformities can be isolated (affecting only one or two toes), be the consequence of a general condition (especially neurological pathology), or the result of deformity of the big toe. These deformities are quite varied as they can affect the three phalanges, the three joints (metatarsophalangeal, proximal interphalangeal, or distal interphalangeal), and the two tendon systems (flexors and extensors). Among all possible deformities, we thus speak of: “Clinodactyly” for deformations in the horizontal plane (toes are deviated inward or outward); “Hammer toe” for a flexion deformity affecting the distal interphalangeal joint; “Total claw” for a flexion deformity involving both the proximal and distal interphalangeal joints. These claw deformities can be reducible (“flexible claws”) or irreducible (“fixed claws”). THE CLINIC : These deformities will cause excessive pressure between the toes, between the toe and the ground, or between the toe and the shoe. Unlike normal pressure exerted between the ground and the toe pad (fleshy and cushioning area), the hyperpressure of a claw sits on a thin and exposed area, making it particularly painful. This hyperpressure clinically manifests as localized pain and hyperkeratosis (callus or corn). These calluses generally occur on the dorsal part of the joints but can also occur at the end of the toe on the pad and the nail (in the case of distal clawing), or on the lateral sides of the toes (in interdigital conflicts), forming a “corn.” These calluses can progress to skin ulcerations that may lead to bone infection (osteitis), joint infection (arthritis), or infection of tendon tissues and fatty tissues (phlegmon). DIAGNOSIS : The consultation with a specialist is motivated by toe pain, corns, skin ulcers, and difficulty with footwear. The diagnosis is primarily clinical, based on the deformity of one or more toes with the possible presence of corns. Radiographic evaluation is generally performed to assess the bone segments and joints. Ultrasound may be useful for studying peri-articular tissues (plantar plates) or tendon structures. CT scans and MRI can assess bone and tissue structures. NON-SURGICAL TREATMENTS SURGICAL TREATMENTS ANESTHESIA NON-SURGICAL TREATMENTS Footwear modification is a first possibility: wearing wide and flexible shoes, or even specialized footwear, reduces contact and pressure on painful areas. Engaging in rehabilitation sessions and stretching exercises, which combat deformation, is also an option. The use of foot orthotics (podiatrist insoles) can reduce pain by unloading painful areas and rebalancing ground pressure. Custom-made and removable toe orthoses (elastic toe splints) can alleviate pain by maintaining the toes in a favorable position. SURGICAL TREATMENTS Surgical intervention may be recommended when deformities are too severe or conservative treatment proves ineffective. All components of the deformity can be addressed: Bony deformity may be corrected through bone shortening or axis correction (osteotomy), which will then consolidate in a more favorable position. Articular deformity can be corrected by releasing the joint (arthrolysis), immobilizing it in a proper position (arthrodesis), or eliminating it through simple resection (arthroplasty). Tendinous deformity can be corrected through tendon release (tenotomy) or lengthening of the retracted tendon. Modifications of tendon trajectory or insertion may also be performed to correct clawing. ANESTHESIA A preoperative consultation with an anesthesiologist is mandatory. During this consultation, the anesthesiologist will explain the anesthesia options tailored to the surgery and your health issues. Anesthesia may include local (numbing of the affected toe and metatarsal), regional (numbing a larger area from the leg to the toes), spinal (numbing the pelvic area and limbs by injecting between two vertebrae), or general anesthesia. During this consultation, your current medication regimen will also be reviewed. HOSPITALIZATION : The procedure is performed on an outpatient basis in the vast majority of cases. DURATION OF THE PROCEDURE The duration of the procedure varies widely depending on the extent of the deformity and the

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Toe clawing refers to deformities of the lateral toes, either in the horizontal and/or vertical planes. These toe claw deformities can lead to abnormal weight-bearing on the ground or in footwear, creating painful areas of hyper-pressure (“corns” or “calluses”). We will not detail here the deformities of the hallux (1st toe or “big toe”) but only those of the adjacent toes (from the 2nd to the 5th toes).

ANATOMY :

Toe or “toe fingers” constitute the termination of the forefoot. They serve a function in walking, as well as in balance and posture. The lateral toes are composed of a bony skeleton of 3 phalanges (proximal, middle, and distal phalanx) extending from the bony skeleton of the metatarsals.

There are thus 3 articulations:

  1. The metatarsophalangeal joint (MTP) between the metatarsal and the proximal phalanx;
  2. The proximal interphalangeal joint (PIP) between the proximal and middle phalanges;
  3. The distal interphalangeal joint (DIP) between the middle and distal phalanges.

These articulations are held together by a fibrous system allowing the mobilization of the two bony pieces relative to each other (“the joint capsule”), reinforced laterally by ligaments.

At its lower (plantar) part, the joint is reinforced by a thicker structure allowing it to resist pressure, the “plantar plate”.

The movement of these articulations is ensured by extensor and flexor tendons, respectively serving to extend and flex the toes. These tendons insert on the phalanges, the flexors on the underside, and the extensors on the upper side.

The distal phalanx carries the nail on its upper (dorsal) part and the pulp on its lower surface (plantar part). The toes possess numerous and important nerve endings, originating from 2 digital nerves (1 on each side of the toe), dividing into multiple microscopic nerve fibers ensuring sensitivity. This rich innervation explains the significant pain present in the pathology of these toes.

THE PATHOLOGY :

In the normal state, the toes are aligned next to each other, with contact on the ground at the pulp level. Their mobility is more limited than that of the hands but still allows for some lifting or flexion movements on the ground.

Toe claws encompass any deformity of the toes in the horizontal and/or vertical plane. These deformities result from disorders of bone orientation, tendon retractions, or joint abnormalities. These deformities can be isolated (affecting only one or two toes), be the consequence of a general condition (especially neurological pathology), or the result of deformity of the big toe. These deformities are quite varied as they can affect the three phalanges, the three joints (metatarsophalangeal, proximal interphalangeal, or distal interphalangeal), and the two tendon systems (flexors and extensors).

Among all possible deformities, we thus speak of:

  1. “Clinodactyly” for deformations in the horizontal plane (toes are deviated inward or outward);
  2. “Hammer toe” for a flexion deformity affecting the distal interphalangeal joint;
  3. “Total claw” for a flexion deformity involving both the proximal and distal interphalangeal joints.

These claw deformities can be reducible (“flexible claws”) or irreducible (“fixed claws”).

THE CLINIC :

These deformities will cause excessive pressure between the toes, between the toe and the ground, or between the toe and the shoe. Unlike normal pressure exerted between the ground and the toe pad (fleshy and cushioning area), the hyperpressure of a claw sits on a thin and exposed area, making it particularly painful.

This hyperpressure clinically manifests as localized pain and hyperkeratosis (callus or corn).

These calluses generally occur on the dorsal part of the joints but can also occur at the end of the toe on the pad and the nail (in the case of distal clawing), or on the lateral sides of the toes (in interdigital conflicts), forming a “corn.”

These calluses can progress to skin ulcerations that may lead to bone infection (osteitis), joint infection (arthritis), or infection of tendon tissues and fatty tissues (phlegmon).

DIAGNOSIS :

The consultation with a specialist is motivated by toe pain, corns, skin ulcers, and difficulty with footwear. The diagnosis is primarily clinical, based on the deformity of one or more toes with the possible presence of corns.

Radiographic evaluation is generally performed to assess the bone segments and joints. Ultrasound may be useful for studying peri-articular tissues (plantar plates) or tendon structures. CT scans and MRI can assess bone and tissue structures.

HOSPITALIZATION :

The procedure is performed on an outpatient basis in the vast majority of cases.

The duration of the procedure varies widely depending on the extent of the deformity and the number of toes to be operated on. An average duration of one hour is typical.

During the surgical procedure, you will be positioned supine on the operating table. This positioning allows your surgeon to access the dorsal part of the forefoot, between the toes, or even the plantar part. The incisions vary in size but typically do not exceed 2-3 cm.

Additionally, do not be surprised if you are asked to confirm your identity and the side to be operated on multiple times upon arrival and during the setup in the operating room. This is a mandatory procedure for all patients to ensure safety and accuracy.

The goal of toe claw surgery is to address all components of the deformity, whether they are related to tendons, bones, or joints. Thus, your surgeon may perform various procedures based on your specific deformity:

Bone and Joint Procedures:

  • Osteotomy: This involves cutting a bone segment to realign it and correct the deformity. It can be performed on any of the three bone phalanges or the metatarsal.
  • Resection Arthroplasty: This entails the removal of deformed joint surfaces through a dorsal incision, allowing proper alignment of the bone segments. A fibrous scar forms in the space left by the removed joint surface, contributing to maintaining the correction.
  • Arthrodesis: This involves stabilizing and fusing the joint in the correct position using temporary pins, screws, or implants.
  • Arthrolysis: This procedure releases adhesions around a deformed joint to allow it to resume a more favorable position.

Tendon Procedures:

  • Tenotomy: Cutting the retracted tendons responsible for or perpetuating the deformity.
  • Tendon Lengthening: Lengthening certain tendons to reduce the traction they exert on the bone segments where they insert.
  • Tendon Transfers: Redirecting a retracted tendon to a location where it will counteract the deformity.

These surgical techniques may require the placement of operative materials to stabilize the correction. These materials can include screws, pins, plates, metallic or non-metallic implants. Some materials, such as certain pins, may be visible initially and removed after a few weeks. Others are intended to remain implanted.

During the procedure, unexpected or unusual situations may arise, necessitating additional or alternative actions. Your surgeon will explain the surgical approach and procedures performed once you are awake and the surgery is complete.

POSTOPERATIVE PAIN varies depending on the extent of the intervention: a procedure involving bone and soft tissues on all five toes will be more intense than a solely tendon procedure on one toe… although strong painkillers may be used immediately after, returning home with simple painkillers is standard. Anticoagulant injections may also be prescribed depending on your health status and the extent of the intervention.

WEIGHT-BEARING is generally allowed with a post-operative shoe or roomy footwear. For more fragile patients, crutches may be used to prevent falls due to clumsiness. In general, you will be able to manage daily activities at home independently, but driving or engaging in sports may not be possible initially…

DRESSINGS are carefully done during the procedure according to your surgeon’s routine, and usually should not be altered. Particularly in percutaneous surgery, dressings are more specific and performed by your surgeon and their team. However, if home care is necessary, it’s important to maintain hygiene around the incision while the stitches are present and it’s not completely sealed. Hand hygiene is crucial, and the incision should never be touched without washing hands. Always ensure you have a hand washing point or a bottle of hand sanitizer for the nurse who will perform your care.

PREVENTION OF THROMBOPHLEBITIS Prescribing anticoagulant injections is rare in this type of surgery but may be considered based on assessment of your health by the surgeon and anesthesiologist.

POSTOPERATIVE EDEMA (swelling of the foot and toes) is common in ankle and foot surgery and is not a complication. Managing the swelling is essential not only for pain relief but also to improve wound healing quality: thus, a period of rest, elevation, and wearing compression stockings or varicose vein stockings may be helpful. This edema can last for a long time (several weeks to several months) and usually does not cause issues; it may require temporary shoe adjustments.

POSTOPERATIVE FOLLOW-UP is crucial. It spans over several months, allowing for monitoring of wound healing, multiple dressing changes, and guiding toe consolidation into the desired position.

These appointments will also be an opportunity to review pain management and start rehabilitation (either by yourself or with a physiotherapist). You will also be guided on footwear adaptation.

AFTER THE INTERVENTION ?

In the absence of intervention, these toe clawing deformities continue to worsen. Footwear becomes increasingly difficult or even impossible, affecting your ability to walk… The goal of surgery is to achieve toes that lie flat with contact on the ground.

However, the postoperative result naturally depends on the initial deformity: for mildly deformed claws, complete reduction of the deformity will be the goal, whereas for the most severe cases, the aim is to regain wide and comfortable footwear.

Adapted from the information sheet of the French Society of Foot Surgery (Société Française de Chirurgie du Pied – SFCP).

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]]> MORTON’S NEUROMA https://drmajedissa.com/en/mortons-neuroma/ Mon, 05 Feb 2024 18:06:40 +0000 https://drmajedissa.com/?p=9230 ANATOMY : At the level of the toes, sensitivity is ensured by the plantar interdigital nerves, whose division branches ensure the sensitivity of the interdigital commissure. Just before their division, at the level of the space between the metatarsal heads, these nerves pass through a fibrous tunnel called the “metatarsal canal.” The walls of this tunnel are formed: at the bottom by the superficial transverse ligament, at the top by the intermetatarsal transverse ligament, and laterally by fibrous septa connecting these two ligaments. Just above the intermetatarsal canal is a space limited laterally by the metatarsals (bones of the forefoot) containing the tendons of the lumbrical and interosseous muscles and a synovial bursa. PATHOLOGY : During walking, at the moment of foot impulses on the ground, the nerve is repetitively compressed within the metatarsal canal. This compression can be exacerbated by narrow footwear. This results in nerve irritation. CLINICAL FEATURES : Most often, this nerve compression manifests as the onset of severe pain beneath and between the toes. These pains are often experienced as electric shocks, they may radiate towards the tips of the toes or up towards the ankle. They are generally triggered by walking or prolonged standing, especially if you wear tight shoes. During a painful episode, removing your shoes and massaging your foot can help alleviate the pain. A tingling sensation or a decrease in sensitivity between the toes is also possible. It is possible to have multiple Morton’s neuromas on the same foot or to have concurrent involvement of both feet. DIAGNOSIS : During your examination, your surgeon will seek to locate your pain. They will also use specific tests to pinpoint the Morton’s neuroma(s). They may also look for a decrease in sensitivity between the toes. An ultrasound or MRI may be ordered by your physician or surgeon to visualize the swelling of the nerve or its compression by a neighboring structure. X-rays of the foot are frequently performed to rule out other bone or joint pathologies. These examinations can also be used to search for pathologies often associated with Morton’s neuroma or to distinguish it from other diseases with similar clinical signs. TREATMENT OPTIONS : Firstly, it is recommended to adjust your footwear by wearing shoes with a wide toe box that do not compress the front of the foot and to avoid high-heeled shoes. Orthopedic insoles (made by a podiatrist) to be worn systematically in your shoes and tailored to your morphology may be prescribed. Their purpose is to reduce repeated pressure on the nerve and thus decrease its irritation. One or more corticosteroid injections may be administered to decrease or eliminate signs of the condition. When the injection is effective, the relief obtained may be temporary or permanent. Unfortunately, these treatments do not always control the pain associated with the condition and may be ineffective for some patients. Your surgeon may then suggest surgical treatment aimed at either freeing the intermetatarsal nerve (“neurolysis”) or removing it (“neurectomy”). In cases where no treatment is undertaken, the pain tends to worsen, resulting in increasingly significant discomfort during walking and wearing shoes. HOSPITALIZATION : Your hospitalization can be outpatient (a day hospitalization) or last for a few days depending on your associated conditions, as well as your medical and social situation. ANESTHESIA : A preoperative consultation with an anesthesiologist is mandatory. During this consultation, the anesthesiologist will explain the modalities and possible choices of anesthesia tailored to the surgery and your health issues. During this consultation, your current medication regimen will also be reviewed. New medications may be initiated, either before or after the surgery. The most commonly used ones include anticoagulants, antibiotics, analgesics, anti-inflammatories, etc. They naturally carry specific risks. The operative anesthesia may be locoregional (wider anesthesia encompassing a segment of the limb, from the leg to the toes), spinal (anesthesia of the pelvis and limbs by puncturing between two vertebrae), or general anesthesia. Blood transfusion is rare in this type of surgery where bleeding is very limited. SURGERIES : During the procedure, your surgeon may encounter an unexpected or unusual situation or event necessitating additional or different actions from those initially planned. Once awake and the surgery is completed, your surgeon will explain the course of action and the procedures performed to you. NEUROLYSIS Neurolysis involves surgically decompressing the nerve. The procedure typically takes place with the patient lying on their back, a pneumatic tourniquet positioned on the ankle, leg, or even thigh, depending on the type of anesthesia used. The location and size of the scar vary depending on your condition, work habits, and the technique chosen by your surgeon. Usually, the scar is approximately 4 to 5 cm in length. This decompression can be performed through a dorsal incision. NEURECTOMY The principle of this intervention is to surgically remove the nerve responsible for the pain. During the surgical procedure, you will be positioned on your back, and a pneumatic tourniquet will be used (positioned on the ankle, leg, or even thigh, depending on the type of anesthesia used). Again, the location and size of the scar vary depending on your condition, work habits, and the technique chosen by your surgeon. It can be performed through a scar located on the top of the foot (Diagram 1), on the sole of the foot (Diagram 3), or in the interdigital commissure (Diagram 2). This intervention frequently results in anesthesia (loss of sensation) or a decrease in sensitivity in the space between the affected toes. For example, during the removal of a neuroma located between the 2nd and 3rd toes, the altered sensitivity will affect the outer aspect of the 2nd toe and the inner aspect of the 3rd toe. ANOTHER SURGICAL PROCEDURE During your time in the operating room, do not be surprised if you are asked multiple times for your identity, the side to be operated on (upon your arrival, during your preparation): this is a mandatory procedure for all patients (referred to as “safety checklist”) and mandated by the

L’article MORTON’S NEUROMA est apparu en premier sur Dr Majed Issa.

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ANATOMY :

At the level of the toes, sensitivity is ensured by the plantar interdigital nerves, whose division branches ensure the sensitivity of the interdigital commissure. Just before their division, at the level of the space between the metatarsal heads, these nerves pass through a fibrous tunnel called the “metatarsal canal.” The walls of this tunnel are formed: at the bottom by the superficial transverse ligament, at the top by the intermetatarsal transverse ligament, and laterally by fibrous septa connecting these two ligaments. Just above the intermetatarsal canal is a space limited laterally by the metatarsals (bones of the forefoot) containing the tendons of the lumbrical and interosseous muscles and a synovial bursa.

PATHOLOGY :

During walking, at the moment of foot impulses on the ground, the nerve is repetitively compressed within the metatarsal canal. This compression can be exacerbated by narrow footwear. This results in nerve irritation.

CLINICAL FEATURES :

Most often, this nerve compression manifests as the onset of severe pain beneath and between the toes.

These pains are often experienced as electric shocks, they may radiate towards the tips of the toes or up towards the ankle. They are generally triggered by walking or prolonged standing, especially if you wear tight shoes.

During a painful episode, removing your shoes and massaging your foot can help alleviate the pain. A tingling sensation or a decrease in sensitivity between the toes is also possible.

It is possible to have multiple Morton’s neuromas on the same foot or to have concurrent involvement of both feet.

DIAGNOSIS :

During your examination, your surgeon will seek to locate your pain. They will also use specific tests to pinpoint the Morton’s neuroma(s). They may also look for a decrease in sensitivity between the toes.

An ultrasound or MRI may be ordered by your physician or surgeon to visualize the swelling of the nerve or its compression by a neighboring structure. X-rays of the foot are frequently performed to rule out other bone or joint pathologies.

These examinations can also be used to search for pathologies often associated with Morton’s neuroma or to distinguish it from other diseases with similar clinical signs.

TREATMENT OPTIONS :

Firstly, it is recommended to adjust your footwear by wearing shoes with a wide toe box that do not compress the front of the foot and to avoid high-heeled shoes.

Orthopedic insoles (made by a podiatrist) to be worn systematically in your shoes and tailored to your morphology may be prescribed. Their purpose is to reduce repeated pressure on the nerve and thus decrease its irritation.

One or more corticosteroid injections may be administered to decrease or eliminate signs of the condition. When the injection is effective, the relief obtained may be temporary or permanent.

Unfortunately, these treatments do not always control the pain associated with the condition and may be ineffective for some patients. Your surgeon may then suggest surgical treatment aimed at either freeing the intermetatarsal nerve (“neurolysis”) or removing it (“neurectomy”).

In cases where no treatment is undertaken, the pain tends to worsen, resulting in increasingly significant discomfort during walking and wearing shoes.

HOSPITALIZATION :

Your hospitalization can be outpatient (a day hospitalization) or last for a few days depending on your associated conditions, as well as your medical and social situation.

ANESTHESIA :

A preoperative consultation with an anesthesiologist is mandatory. During this consultation, the anesthesiologist will explain the modalities and possible choices of anesthesia tailored to the surgery and your health issues.

During this consultation, your current medication regimen will also be reviewed. New medications may be initiated, either before or after the surgery. The most commonly used ones include anticoagulants, antibiotics, analgesics, anti-inflammatories, etc. They naturally carry specific risks.

The operative anesthesia may be locoregional (wider anesthesia encompassing a segment of the limb, from the leg to the toes), spinal (anesthesia of the pelvis and limbs by puncturing between two vertebrae), or general anesthesia.

Blood transfusion is rare in this type of surgery where bleeding is very limited.

SURGERIES :

During the procedure, your surgeon may encounter an unexpected or unusual situation or event necessitating additional or different actions from those initially planned. Once awake and the surgery is completed, your surgeon will explain the course of action and the procedures performed to you.

Neurolysis involves surgically decompressing the nerve. The procedure typically takes place with the patient lying on their back, a pneumatic tourniquet positioned on the ankle, leg, or even thigh, depending on the type of anesthesia used. The location and size of the scar vary depending on your condition, work habits, and the technique chosen by your surgeon. Usually, the scar is approximately 4 to 5 cm in length. This decompression can be performed through a dorsal incision.

The principle of this intervention is to surgically remove the nerve responsible for the pain. During the surgical procedure, you will be positioned on your back, and a pneumatic tourniquet will be used (positioned on the ankle, leg, or even thigh, depending on the type of anesthesia used). Again, the location and size of the scar vary depending on your condition, work habits, and the technique chosen by your surgeon. It can be performed through a scar located on the top of the foot (Diagram 1), on the sole of the foot (Diagram 3), or in the interdigital commissure (Diagram 2). This intervention frequently results in anesthesia (loss of sensation) or a decrease in sensitivity in the space between the affected toes. For example, during the removal of a neuroma located between the 2nd and 3rd toes, the altered sensitivity will affect the outer aspect of the 2nd toe and the inner aspect of the 3rd toe.

During your time in the operating room, do not be surprised if you are asked multiple times for your identity, the side to be operated on (upon your arrival, during your preparation): this is a mandatory procedure for all patients (referred to as “safety checklist”) and mandated by the Health Authority (HAS).

POSTOPERATIVE CARE :

Specific postoperative footwear is often prescribed according to your surgeon’s protocol.

The dressing is carefully applied during the surgery according to your surgeon’s habits and is usually not to be changed. However, if home care is provided, it is important to ensure the hygiene of your incision as long as the stitches are in place and it is not completely sealed.

Hand hygiene is crucial, and one should never touch the incision without washing hands. Always ensure that you have hand washing facilities or a bottle of hand sanitizer at home for the nurse who will perform your care. On average, care is scheduled for a duration of 15 days to one month.

Prevention of blood clots: The prescription of anticoagulant injections is sometimes considered based on the assessment of your health condition by the surgeon and the anesthesiologist.

Postoperative pain management for this type of condition generally poses few difficulties. Even though strong painkillers may be used immediately after surgery, returning home with simple painkillers is the norm.

Postoperative swelling (swelling of the foot and toes) is common in ankle and/or foot surgery and is usually not a complication. Managing swelling is essential not only to alleviate pain but also to improve the quality of healing. Thus, a certain period of rest, elevation, and the use of compression stockings or varicose vein stockings can be helpful. This swelling can last a long time (several weeks to several months) and usually does not cause any problems, although it may require temporarily adapting footwear.

A period of leave from work is generally necessary after surgery. Its duration is on average one month but depends on your professional activity and the surgical procedures performed.

Postoperative follow-up consultations: Your surgeon will conduct regular clinical, radiological, and biological checks, and the results will be incorporated into your medical record.

The (anonymous) data from your record may be used for studies and/or scientific communications or publications by your surgeon, in compliance with the JARDE law of March 2012 (Decree 2016-1537). In this case, specific consent will be requested by your surgeon and included in your record. Initial consultations focus on monitoring healing and local condition. Subsequent consultations involve monitoring the progress of the procedures performed and your functional recovery.

The implementation of possible functional rehabilitation and the validation of the return to work and sports will be done according to your surgeon’s protocol.

AFTER THE INTERVENTION ?

The aim of the surgery proposed by your surgeon is to alleviate or ideally eliminate the pain associated with Morton’s neuroma.

RISKS :

A surgical procedure is NEVER a trivial matter. Regardless of the precautions taken, there is no such thing as “zero risk.” When you decide to undergo surgery, you must be aware of this and weigh the risks against the expected benefits of the procedure (= benefit/risk balance).

Despite the skills of your surgeon and the team caring for you, unfortunately, every treatment carries a risk of failure. This failure can range from the reappearance of symptoms to their worsening or other more significant risks. These risks may be due to chance, bad luck, but may also be exacerbated by health issues specific to you (known or unknown, local or general).

It is impossible to present here all possible complications, but we have listed below the most common or serious complications that may sometimes occur in your condition.

RESIDUAL PAIN DUE TO OTHER FOREFOOT PATHOLOGIES :

In cases where Morton’s neuroma is associated with other bone or joint pathologies, the clinical outcome of isolated management of the neuroma may be incomplete.

SCARRING ISSUES

Despite all the care provided by your surgeon to the surgical wound and nursing care, there may be healing disturbances, sometimes exacerbated by a general or local pathology such as diabetes or circulatory insufficiencies, for example. This can result in delayed or impaired healing ranging from an unsightly scar to wound dehiscence or skin necrosis. These scarring issues can also predispose to infection.

L’article MORTON’S NEUROMA est apparu en premier sur Dr Majed Issa.

]]> PLANTAR APONEUROSIS (CALCANEAL SPUR) https://drmajedissa.com/en/plantar-aponeurosis-calcaneal-spur/ Sun, 04 Feb 2024 16:44:56 +0000 https://drmajedissa.com/?p=9206 ANATOMY The plantar aponeurosis, or plantar fascia, is a thick fibrous membrane located on the plantar (bottom) surface of the foot. It has a triangular shape, with its posterior part attaching to the calcaneus (heel bone) and widening towards the front of the foot to end at the metatarsal heads. Its role is to support the arch of the foot and protect the overlying tendons. This membrane is part of a larger fibrous complex known as the Suro-Achilleo-Plantar complex. In fact, the plantar aponeurosis is a continuation of the posterior leg fascia (Achilles aponeurosis). Thus, this fibrous complex originates behind the knee, extends behind the leg through the Achilles tendon, reflects on the calcaneus (heel bone), and terminates at the metatarsal heads. The plantar aponeurosis can be seen as the plantar part of a more comprehensive structure. PATHOLOGY : Inflammation of the plantar aponeurosis occurs due to abnormal or repetitive stresses on it. This can occur during significant physical activities such as long walks or running, as well as due to structural abnormalities in the rearfoot, whether they are static (flat feet, high arches) or dynamic (valgus, pronation, varus), leading to excessive tension on the aponeurosis. Mechanical factors like overweight or heavy lifting can also contribute to this condition. The stress on the aponeurosis results in mechanical forces on both of its insertions: these stresses are distributed over a wide area in the front (lower pressure), but are concentrated in a very limited area in the rear, at the calcaneal insertion, where the pressures are highest. Therefore, it is this significant tension in a limited area that causes heel pain and potential radiographic signs. THE CLINIC : Plantar fasciitis is the main cause of heel pain or “talalgia”. It is characterised by pain in the heel, aggravated by weight-bearing and walking, forcing patients to walk on the forefoot or the outer edge of the midfoot. THE DIAGNOSIS : The diagnosis is primarily clinical, based on pain elicited by palpation of the underside of the heel, often on the inner side, sometimes on the outer side. The pain is also reproduced by tensioning the fascia, by dorsiflexion of the ankle with pressure on the metatarsal heads. Radiographic evaluation is used to look for signs of severity or chronicity, such as ossification at its calcaneal insertion (hence the name “heel spur” or LENOIR spur). MRI and ultrasound can confirm the diagnosis by revealing inflammation of the fascia and searching for signs of severity (fissures). MEDICAL TREATMENTS (NON-SURGICAL) SURGICAL TREATMENT MEDICAL TREATMENTS (NON-SURGICAL) The adaptation of footwear with more cushioning and a slight heel is a simple way to reduce pain at the beginning of the symptoms. Medications (pain relievers and anti-inflammatories) prescribed by your primary care physician can help combat acute pain and inflammation. Reducing contributing factors such as rest or weight loss should be the first measures considered. Correcting structural foot problems with the use of orthotic insoles (orthopedic shoe inserts) is an excellent way to relieve inflammation of the plantar fascia. Rehabilitation physiotherapy, involving stretching of the plantar fascia and the entire suro-achilleo-plantar chain, helps reduce pressure and inflammation. Deep transverse massages can also be performed. The use of shockwaves, mesotherapy, or local cortisone injections is excellent therapeutic methods to reduce inflammation. Without treatment, heel pressure becomes increasingly painful, leading to limping with a lack of support and difficulties in wearing shoes. In the worst-case scenario, fibrous nodules can form within the inflamed plantar fascia, and even a rupture of the fascia can occur. SURGICAL TREATMENT Important Point: The “ossification” image at the insertion point of the plantar fascia on the heel bone is often misinterpreted by patients as the cause of their pain, resembling a “painful spur” that should be removed. However, this “bony spur” is not inherently painful; it is merely a reflection of the mechanical tension at the bone insertion of the plantar fascia. Therefore, treatment involves lengthening the plantar fascia, and the removal of the ossification has no benefit! When conservative treatment is insufficient, surgical intervention may be proposed. Surgical treatment involves partial or total sectioning of the plantar fascia, which then heals in a relaxed position, reducing pressure within it. Inflammation subsequently resolves on its own. Sometimes, surgical treatment is part of a more comprehensive approach to correcting structural abnormalities in the midfoot or hindfoot. The procedure on the plantar fascia is just one step in releasing the midfoot or hindfoot. HOSPITALIZATION : Hospitalization is typically done on an outpatient basis, meaning you may go home on the same day as the surgery. However, in some cases, a one-night hospital stay may be required due to health issues or social isolation. The decision regarding the length of hospitalization will be made based on your specific health condition and needs. THE ANESTESIA : A preoperative consultation with an anesthesiologist is mandatory. During this consultation, the anesthesiologist will explain to you the methods and possible choices for anesthesia that are tailored to the surgery and your health condition. During this consultation, your current medication regimen will also be reviewed. New medications may be prescribed, either before or after the surgery. The most commonly used medications include anticoagulants, antibiotics, pain relievers, and anti-inflammatories, each of which carries specific risks. The type of anesthesia used during the surgery can be regional (affecting a specific segment of the body, from the leg to the toes), spinal (affecting the pelvis and limbs by injecting between two vertebrae), or general anesthesia. THE TECHNIQUE: The surgery lasts approximately 30 to 45 minutes and involves the partial or total sectioning of the plantar fascia a few centimeters before its insertion into the calcaneus. The fascia then heals spontaneously in a relaxed position over a few weeks, reducing pressure on the bone insertions, especially at the calcaneal insertion point. The incision is made on the inner side of the heel, and its length depends on the surgical technique used. Several surgical techniques are possible: “Open” surgery, which is performed under direct vision through a

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ANATOMY

The plantar aponeurosis, or plantar fascia, is a thick fibrous membrane located on the plantar (bottom) surface of the foot. It has a triangular shape, with its posterior part attaching to the calcaneus (heel bone) and widening towards the front of the foot to end at the metatarsal heads.

Its role is to support the arch of the foot and protect the overlying tendons.

This membrane is part of a larger fibrous complex known as the Suro-Achilleo-Plantar complex. In fact, the plantar aponeurosis is a continuation of the posterior leg fascia (Achilles aponeurosis).

Thus, this fibrous complex originates behind the knee, extends behind the leg through the Achilles tendon, reflects on the calcaneus (heel bone), and terminates at the metatarsal heads.

The plantar aponeurosis can be seen as the plantar part of a more comprehensive structure.

PATHOLOGY :

Inflammation of the plantar aponeurosis occurs due to abnormal or repetitive stresses on it. This can occur during significant physical activities such as long walks or running, as well as due to structural abnormalities in the rearfoot, whether they are static (flat feet, high arches) or dynamic (valgus, pronation, varus), leading to excessive tension on the aponeurosis.

Mechanical factors like overweight or heavy lifting can also contribute to this condition. The stress on the aponeurosis results in mechanical forces on both of its insertions: these stresses are distributed over a wide area in the front (lower pressure), but are concentrated in a very limited area in the rear, at the calcaneal insertion, where the pressures are highest.

Therefore, it is this significant tension in a limited area that causes heel pain and potential radiographic signs.

THE CLINIC :

Plantar fasciitis is the main cause of heel pain or “talalgia”. It is characterised by pain in the heel, aggravated by weight-bearing and walking, forcing patients to walk on the forefoot or the outer edge of the midfoot.

THE DIAGNOSIS :

The diagnosis is primarily clinical, based on pain elicited by palpation of the underside of the heel, often on the inner side, sometimes on the outer side.

The pain is also reproduced by tensioning the fascia, by dorsiflexion of the ankle with pressure on the metatarsal heads. Radiographic evaluation is used to look for signs of severity or chronicity, such as ossification at its calcaneal insertion (hence the name “heel spur” or LENOIR spur).

MRI and ultrasound can confirm the diagnosis by revealing inflammation of the fascia and searching for signs of severity (fissures).

HOSPITALIZATION :

Hospitalization is typically done on an outpatient basis, meaning you may go home on the same day as the surgery. However, in some cases, a one-night hospital stay may be required due to health issues or social isolation. The decision regarding the length of hospitalization will be made based on your specific health condition and needs.

THE ANESTESIA :

A preoperative consultation with an anesthesiologist is mandatory. During this consultation, the anesthesiologist will explain to you the methods and possible choices for anesthesia that are tailored to the surgery and your health condition.

During this consultation, your current medication regimen will also be reviewed. New medications may be prescribed, either before or after the surgery. The most commonly used medications include anticoagulants, antibiotics, pain relievers, and anti-inflammatories, each of which carries specific risks.

The type of anesthesia used during the surgery can be regional (affecting a specific segment of the body, from the leg to the toes), spinal (affecting the pelvis and limbs by injecting between two vertebrae), or general anesthesia.

THE TECHNIQUE:

The surgery lasts approximately 30 to 45 minutes and involves the partial or total sectioning of the plantar fascia a few centimeters before its insertion into the calcaneus. The fascia then heals spontaneously in a relaxed position over a few weeks, reducing pressure on the bone insertions, especially at the calcaneal insertion point.

The incision is made on the inner side of the heel, and its length depends on the surgical technique used.

Several surgical techniques are possible:

  1. “Open” surgery, which is performed under direct vision through a short incision of less than 10 cm.
  2. Percutaneous surgery, involving a small puncture incision of a few millimeters, allowing the sectioning of the fascia using a fine scalpel, guided by a fluoroscope (a type of X-ray machine) to monitor the instrument’s position.
  3. Endoscopy: This involves using a camera inserted through an incision of approximately 1 centimeter, allowing the guided sectioning of the fascia through a video image.

A tourniquet is often used to temporarily stop blood flow to the surgical area. It can be placed at the thigh, leg, or ankle level.

During the surgery, unexpected or unusual situations or events may require additional or different procedures than originally planned. After awakening and when the surgery is completed, your surgeon will explain the procedure and any additional steps that were taken.

POST-OPERATIVE CARE :

SUPPORT

Depending on your surgeon's practices and the surgical technique, you may be prescribed immobilization for a few weeks. Partial weight-bearing is usually allowed (the use of crutches is possible) during the first few weeks, depending on pain levels.

Wearing wide but closed shoes is typically resumed around the 3rd week. Returning to regular footwear usually occurs between 2 and 3 months.

POST-OPERATIVE OEDEMA

Swelling (swelling of the foot and toes) is common in foot surgery and is not a complication. Managing swelling is essential not only to alleviate pain but also to improve the quality of healing: thus, a period of rest, elevation, and the use of vein support (compression stockings or varicose stockings) can be helpful.

This swelling can last a long time (several weeks, even months) and usually does not lead to any significant issues. It may temporarily require adjusting footwear.

PAIN

Post-operative pain from this type of pathology generally poses little difficulty. Even though strong painkillers may be used in the immediate aftermath, going home with simple analgesics is the norm.

Sometimes, a more or less prolonged and complete anesthesia of the operated limb (anesthetic block or loco-regional anesthesia) is also used to decrease or eliminate the most significant pains of the first few days. A work stoppage is generally necessary after the surgical procedure. Its duration averages 6 weeks but depends on your professional activity and the surgical procedures performed.

POST-OPERATIVE CONSULTATIONS :

Your surgeon will offer you post-operative monitoring. The frequency will depend on the surgical procedure and your progress. The first consultations will focus on monitoring the healing process, the local condition and the resumption of weight-bearing.

Subsequent consultations will focus on functional recovery, sedation of pain and the return to full weight-bearing.

AND AFTER THE SURGERY ?

Even if the surgery is short and typically done on an outpatient basis, the postoperative recovery is lengthy for pain to decrease (approximately 3 to 6 months).

Indeed, this condition usually develops over many months or years before surgery is considered. Therefore, the time it takes for the inflammatory processes to decrease and for complete healing of the plantar fascia is long and occurs over several weeks.

 

Adapted from the information sheet of the SFCP (French Society of Foot Surgery)

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]]> HALLUX VALGUS https://drmajedissa.com/en/hallux-valgus-2/ Sun, 04 Feb 2024 16:18:15 +0000 https://drmajedissa.com/?p=9152 Hallux valgus is a deviation of the tip of the big toe towards the lateral side, with the formation of a painful bony bump on the medial side of the foot at the joint between the metatarsal and the 1st phalanx. This bump becomes increasingly painful due to friction against the shoe and the joint’s discomfort. The pain tends to spread to the other toes due to crowding and altered mechanical forces in the sole of the foot. The big toe can no longer perform its function of propulsion during walking. As a result, these propulsive forces are distributed to the other toes. In the vast majority of cases, the progression of the deformity is very slow. The normal position of the bones, tendons, and ligaments gradually changes over time. As the big toe tilts towards the second toe, it can overlap it and cause additional issues. This can gradually lead to deformities of the lateral toes, such as hammer or claw toes. Calluses can also develop where the toes rub against each other or against shoes, causing additional discomfort and difficulty in walking. Hallux valgus is more common in women than in men, often with a family and genetic factor. This is particularly true for hallux valgus in adolescents, which develops early in life. Certain inflammatory diseases such as rheumatoid arthritis, neuromuscular conditions like Charcot-Marie-Tooth disease or polio, can predispose to hallux valgus, often in a severe form. Most cases develop in adulthood and result from repetitive microtrauma, often associated with tight footwear around the toes. DIAGNOSIS : Standing X-rays are often sufficient for diagnosis: Measure the alignment of the bones in the toes. Evaluate damage to the metatarsophalangeal joint. Long-standing hallux valgus can be accompanied by arthritic changes. Hallux Valgus X-ray TREATMENT : Non-surgical treatment Surgical Treatment The surgery Les suites post-opératoires Non-surgical treatment In general, non-painful hallux valgus deformities can be managed with non-surgical treatment. A significant portion of mild deformities and discomfort can be successfully managed with proper shoe adjustments. Your surgeon will provide you with information on proper shoe fit and the type of footwear that would suit you best. Custom-made orthopedic insoles, protective silicone pads, and toe spacers worn inside your shoe can help cushion the painful area over the bunion. The effectiveness of orthopedic insoles and small orthoses at this stage is variable, and very few high-quality scientific studies demonstrate their beneficial effects. Common pain relievers and anti-inflammatories can also help alleviate mild and occasional pain. The consumption of large quantities of pain relievers often indicates the need for an alternative solution. Surgical Treatment Surgical correction is considered when pain persists while wearing shoes and walking despite medical treatment. The goal of hallux valgus surgery is to relieve pain by realigning the bone, ligaments, tendons, and nerves so that the big toe can be returned to its correct position and its function in walking propulsion. Aesthetic reasons alone are not sufficient to justify the intervention. The surgery In general, the common goals of most bunion surgeries include: Realignment of the metatarsophalangeal joint (MTP) at the base of the big toe Relieving pain Correcting the deformity of the bones that make up the toe and foot Surgery may involve shortening loose tissues and lengthening tight tissues. This is rarely done without some type of bone realignment, called an osteotomy. In the majority of cases, correction of soft tissues is just one part of the overall bunion corrective procedure. In an osteotomy, your doctor makes small cuts in the bones to realign the joint. After cutting the bone, your doctor repairs this new break with pins, screws, or plates. The bones are now straighter, and the joint is balanced. Osteotomies can be performed at different locations along the bone to correct the deformity. In some cases, in addition to cutting the bone, a small wedge of bone is removed to provide enough correction to straighten the toe. As discussed above, osteotomies are typically performed in combination with soft tissue procedures, as both are often necessary to maintain the alignment of the big toe. Les suites post-opératoires Physiothérapie et exercice ​Des exercices spécifiques aideront à restaurer la force et l’amplitude de mouvement de votre pied après la chirurgie. Votre médecin ou physiothérapeute peut recommander des exercices utilisant une bande chirurgicale pour renforcer votre cheville ou en utilisant des billes pour rétablir le mouvement de vos orteils. Des exercices spécifiques tels que l’exercice de ramassage de billes aideront à restaurer le mouvement complet de votre pied. Commencez toujours ces exercices lentement et suivez les instructions de votre médecin ou de votre physiothérapeute concernant les répétitions. WEARING SHOES : It will take several months for your bones to fully heal. When you have completed the initial rehabilitation period, your doctor will advise you on footwear. Athletic shoes or soft leather oxford-style shoes will provide the best protection for the bunion correction until the bones are completely healed. To help prevent the recurrence of your bunion, avoid wearing fashionable shoes until your doctor permits it. Be aware that your doctor may recommend never wearing high-heeled shoes. Because one of the primary causes of bunion deformity is ill-fitting footwear, returning to this type of shoe can lead to the return of your bunion. Always follow your doctor’s recommendations for proper shoe fit. POSSIBLE COMPLICATIONS : As with any surgical procedure, there are risks associated with bunion surgery. These rarely occur and are generally treatable, although in some cases, they may limit or prolong your full recovery. Before your surgery, your doctor will discuss each of these risks with you and take specific measures to prevent complications. The possible risks and complications of bunion surgery include: Infection Stiffness of the big toe joint Thrombophlebitis Recurrence of the bunion Nerve, tendon, or vascular injury Delayed bone healing Adapted from the information sheet of the French Society of Foot Surgery (SFCP).    

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Hallux valgus is a deviation of the tip of the big toe towards the lateral side, with the formation of a painful bony bump on the medial side of the foot at the joint between the metatarsal and the 1st phalanx. This bump becomes increasingly painful due to friction against the shoe and the joint’s discomfort.

The pain tends to spread to the other toes due to crowding and altered mechanical forces in the sole of the foot.

The big toe can no longer perform its function of propulsion during walking. As a result, these propulsive forces are distributed to the other toes.

In the vast majority of cases, the progression of the deformity is very slow. The normal position of the bones, tendons, and ligaments gradually changes over time.

As the big toe tilts towards the second toe, it can overlap it and cause additional issues. This can gradually lead to deformities of the lateral toes, such as hammer or claw toes.

Calluses can also develop where the toes rub against each other or against shoes, causing additional discomfort and difficulty in walking.

Hallux valgus is more common in women than in men, often with a family and genetic factor. This is particularly true for hallux valgus in adolescents, which develops early in life.

Certain inflammatory diseases such as rheumatoid arthritis, neuromuscular conditions like Charcot-Marie-Tooth disease or polio, can predispose to hallux valgus, often in a severe form.

Most cases develop in adulthood and result from repetitive microtrauma, often associated with tight footwear around the toes.

DIAGNOSIS :

Standing X-rays are often sufficient for diagnosis:

  1. Measure the alignment of the bones in the toes.
  2. Evaluate damage to the metatarsophalangeal joint. Long-standing hallux valgus can be accompanied by arthritic changes.
Hallux Valgus X-ray

TREATMENT :

WEARING SHOES :

It will take several months for your bones to fully heal. When you have completed the initial rehabilitation period, your doctor will advise you on footwear. Athletic shoes or soft leather oxford-style shoes will provide the best protection for the bunion correction until the bones are completely healed.

To help prevent the recurrence of your bunion, avoid wearing fashionable shoes until your doctor permits it. Be aware that your doctor may recommend never wearing high-heeled shoes.

Because one of the primary causes of bunion deformity is ill-fitting footwear, returning to this type of shoe can lead to the return of your bunion. Always follow your doctor’s recommendations for proper shoe fit.

POSSIBLE COMPLICATIONS :

As with any surgical procedure, there are risks associated with bunion surgery. These rarely occur and are generally treatable, although in some cases, they may limit or prolong your full recovery.

Before your surgery, your doctor will discuss each of these risks with you and take specific measures to prevent complications.

The possible risks and complications of bunion surgery include:

  • Infection
  • Stiffness of the big toe joint
  • Thrombophlebitis
  • Recurrence of the bunion
  • Nerve, tendon, or vascular injury
  • Delayed bone healing

Adapted from the information sheet of the French Society of Foot Surgery (SFCP).

 
 

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]]> ANKLE ARTHRODESIS https://drmajedissa.com/en/ankle-arthrodesis/ Sun, 04 Feb 2024 15:43:57 +0000 https://drmajedissa.com/?p=9083 WHAT IS IT? Ankle arthrodesis is a surgical procedure that aims to fuse the joint surfaces of the ankle (tibia and talus). The most common causes of joint damage are osteoarthritis, less commonly rheumatoid arthritis, a previous fracture, or ligament rupture. The natural progression in the absence of treatment is the persistence or worsening of pain. When medical treatment is no longer effective, arthrodesis surgery is an option. BEFORE TREATMENT: A comprehensive radiographic assessment is performed to confirm the diagnosis and plan the surgery. WHAT TREATMENT ? The surgery is performed under general or regional anesthesia. A scar is made on the anterior or lateral aspect of the ankle, with the size adapted to each case. The joint surfaces are cut (tibia and talus) and then fixed using various methods (plate, screws, staples, nail, etc.). At the end of the procedure, a drain is left in place to evacuate any hematoma. The drain will be removed as per the prescription (usually within one or more days). An immobilization boot is worn for six to twelve weeks. AFTERWARDS ? Getting up is allowed the day after the surgery, but weight-bearing is prohibited for a period of six weeks. Rehabilitation begins after the immobilization period is lifted. To prevent blood clots, anticoagulant treatment is prescribed for several weeks. After a few days of hospitalization, your surgeon will authorize your discharge with the necessary care prescriptions (dressings, painkillers, anticoagulants). You will have a follow-up consultation with X-rays. Walking is resumed after six weeks, supported by crutches, with or without a walking boot. The resumption of driving and professional activities will depend on your recovery. COMPLICATIONS ➜ Most Common ➜ Less commonly COMPLICATIONS ➜ Most Common Phlebitis can occur despite anticoagulant treatment. This is a clot that forms in the veins of the legs and can migrate, leading to a pulmonary embolism. Like any surgery, there is a risk of hematoma, which usually resolves on its own. In exceptional cases, it may require needle aspiration or surgical drainage. Wound healing, sometimes difficult to achieve, may require prolonged care. Bone consolidation is achieved within three months. The absence of bone fusion after six months is a sign of failed bone consolidation (nonunion) and may require reoperation based on the experienced pain. ➜ Less commonly Complex regional pain syndrome (CRPS) is a painful and inflammatory phenomenon that is still poorly understood. It is treated medically and can last for several months (sometimes even years), requiring specific management with adapted rehabilitation, additional assessments, and sometimes specific pain management. It is unpredictable in its onset and course, as well as its potential sequelae. Infection is a rare but serious complication. It can occur long after surgery and may result from an infection elsewhere in the body, such as a dental or urinary infection. Infection can lead to further surgery. It is strongly advised not to smoke during the healing period, as smoking significantly increases the risk of infection. Walking comfort depends on the positioning of the ankle arthrodesis. This may require orthopedic insoles, appropriate footwear, or even a reoperation for repositioning. Blocking one joint will lead to overuse of the other joints in the foot, which may deteriorate in the long term and require surgical intervention themselves The list is not exhaustive, and an exceptionally rare complication may occur, related to the local condition or technical variability. Not all complications can be specified, which you have understood and accepted. EXPECTED RESULTS : Recovery and smooth walking require a period of 12 to 18 months. The expected result is pain-free slow walking (strolling). Professional activities are usually resumed after 6 to 12 months (varies greatly depending on the profession and individual cases). Due to ankle fusion, an adaptation of the workplace may be necessary. Physical activities are allowed after several months, depending on the patient’s physical condition and should be approved by your surgeon. In accordance with your surgeon and considering the risk-benefit balance, ankle arthrodesis has been proposed to you. The surgeon has explained other alternatives to you. It goes without saying that your surgeon may, if necessary and based on intraoperative findings or encountered difficulties, choose another technique deemed more suitable for your specific case.

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WHAT IS IT?

Ankle arthrodesis is a surgical procedure that aims to fuse the joint surfaces of the ankle (tibia and talus).

The most common causes of joint damage are osteoarthritis, less commonly rheumatoid arthritis, a previous fracture, or ligament rupture.

The natural progression in the absence of treatment is the persistence or worsening of pain. When medical treatment is no longer effective, arthrodesis surgery is an option.

BEFORE TREATMENT:

A comprehensive radiographic assessment is performed to confirm the diagnosis and plan the surgery.

WHAT TREATMENT ?

The surgery is performed under general or regional anesthesia. A scar is made on the anterior or lateral aspect of the ankle, with the size adapted to each case. The joint surfaces are cut (tibia and talus) and then fixed using various methods (plate, screws, staples, nail, etc.). At the end of the procedure, a drain is left in place to evacuate any hematoma. The drain will be removed as per the prescription (usually within one or more days). An immobilization boot is worn for six to twelve weeks.

AFTERWARDS ?

Getting up is allowed the day after the surgery, but weight-bearing is prohibited for a period of six weeks. Rehabilitation begins after the immobilization period is lifted. To prevent blood clots, anticoagulant treatment is prescribed for several weeks.

After a few days of hospitalization, your surgeon will authorize your discharge with the necessary care prescriptions (dressings, painkillers, anticoagulants). You will have a follow-up consultation with X-rays.

Walking is resumed after six weeks, supported by crutches, with or without a walking boot. The resumption of driving and professional activities will depend on your recovery.

The list is not exhaustive, and an exceptionally rare complication may occur, related to the local condition or technical variability. Not all complications can be specified, which you have understood and accepted.

EXPECTED RESULTS :

Recovery and smooth walking require a period of 12 to 18 months. The expected result is pain-free slow walking (strolling). Professional activities are usually resumed after 6 to 12 months (varies greatly depending on the profession and individual cases). Due to ankle fusion, an adaptation of the workplace may be necessary. Physical activities are allowed after several months, depending on the patient’s physical condition and should be approved by your surgeon.

In accordance with your surgeon and considering the risk-benefit balance, ankle arthrodesis has been proposed to you. The surgeon has explained other alternatives to you. It goes without saying that your surgeon may, if necessary and based on intraoperative findings or encountered difficulties, choose another technique deemed more suitable for your specific case.

L’article ANKLE ARTHRODESIS est apparu en premier sur Dr Majed Issa.

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