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’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.
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 sometimes requires a 1-2 night stay in the hospital but is usually performed as an out-patient. These procedures are preformed 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.
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.
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.
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.