Foot & AnkleDelmarva Orthopaedic Clinic is dedicated to providing state of the art evaluation and treatment of foot and ankle problems. We offer comprehensive, specialized care for virtually all foot and ankle related musculoskeletal ailments. This includes work and sports related injuries, fractures, foot and toe deformities and more.While we specialize in surgery, many lower extremity problems we see can be treated successfully non-operatively. Commons reasons for seeing an orthopaedic foot and ankle specialist include:
The Ankle Joint A joint is a junction where two or more bones meet. The ankle is a complex joint involving three bones - the tibia, the fibula and the talus. The ankle joint allows for an up and down motion, as well as a slight side to side rotation. Ligaments (which connect bone to bone) on the inside and outside of the ankle act to stabilize the joint. When Joint Problems Arise The most frequent source of debilitating pain and joint destruction is arthritis. It is estimated that 36 million people in the United States have some form of arthritis. That's one in seven people. Of the more than 100 types of arthritis, the following three are the most common sources of joint damage: Osteoarthritis, sometimes called degenerative arthritis, is a disease which involves the breakdown of the tissue (cartilage) that normally allows the joint to move smoothly. When the gliding surface of the cartilage is gone, the bones grind against each other, creating popping sounds, pain and loss of normal movement. This condition occurs primarily in people over 50. Traumatic arthritis, or trauma-related arthritis, results when the joint is injured either by fracture, dislocation or damage to the ligaments surrounding the joint. This resulting damage predisposes the joint to traumatic arthritis. Rheumatoid arthritis is considered a systemic disease because it can attack any or all joints of the body. It affects women more often than men and can strike both young and old. Rheumatoid arthritis causes the body's immune system to produce a chemical that attacks and destroys the protective cartilage that covers the joint surface, causing deterioration. Ankle Surgery When conservative measures of treatment fail to provide adequate relief, either an ankle fusion or ankle arthroplasty may be considered. Ankle fusion has been the traditional method of treating arthritis of the ankle. However, due to the detrimental long-term effects ankle fusion has on the other joints in the foot, ankle replacement surgery may be a better alternative. The ankle joint, in the process of wearing out, can either settle with the foot turned in or turned out. Most deformities can be corrected at the time of surgery, but the primary purpose of ankle replacement surgery is to relieve pain. Motion can be gained following replacement surgery, but this is somewhat dependent on the amount of stiffness before surgery and the length of time the joint was stiff. Postoperatively, therapy is important and may be started soon after surgery, based on the advice of your surgeon. Your Ankle Evaluation Your orthopaedic surgeon will evaluate your ankle, determining the type of arthritis you have and other factors important in deciding whether or not an ankle arthroplasty can be expected to be successful. In the process of the examination, not only will the motion of your ankle be measured, but fluid may be taken from the joint to determine if infection is present.X-rays will also be taken to assess the size and condition of your ankle. Components of Ankle Replacement - NEW - Available in 1998! Total ankle replacement removes and then replaces both sides of the ankle joint with specially designed artificial parts, called prostheses. The tibial prosthesis consists of a polyethylene (medical grade plastic) and titanium base plate tray that is inserted into the tibia and fibula, giving the implant a wide base for support. The talar prosthesis, the part that moves up and down, is replaced with a component made of cobalt chromium alloy, a metal commonly used in joint replacement prostheses. One type of ankle prosthesis is made by DePuy, Inc. of Warsaw, Indiana. The Agility™ Total Ankle System design is based on numerous research studies of the structure and mechanics of the ankle joint. Before Your Operation General Medical Health All patients need to see their family physician or an internist for a thorough medical evaluation one to two weeks prior to hospital admission. This will ensure that any medical conditions such as urinary tract infections, cardiac disease or high blood pressure can be detected, treated and controlled prior to surgery - minimizing the possibility of your surgery being rescheduled. Your orthopaedic surgeon will need to obtain a report from your physician regarding your general medical health and copies of test results. You may be asked to obtain these reports from your physician. Some common tests that may be required include a complete blood count, blood clotting times, blood chemistries and urinalysis. For some patients, typically those over 40, a chest x-ray and an electrocardiogram (EKG) may need to be performed. This is usually scheduled two weeks prior to the date of surgery. If any of your test results are abnormal or outdated, you may need to have them repeated upon arrival at the hospital to ensure the safest possible operation. You will likely be asked to complete a past medical history form and bring it with you to the hospital. This information helps ensure that appropriate attention is provided to any medical condition that you may have. In some cases, you may be asked to lose weight. If you smoke, it is important to stop two weeks before surgery. Admission Check with your surgeon to determine when you should plan to arrive at the hospital. Most patients are admitted the day of surgery. Note: You cannot eat or drink anything after midnight of the day prior to surgery. Medications If you are taking any anti-inflammatory medications, your surgeon may advise you to stop taking them one week prior to surgery to help minimize bleeding during your operation. Anti-inflammatory medications include any form of aspirin, including coated or buffered aspirin, Disalcid, Indocin, Tolectin, Clinoril, Naprosyn, Nalfon, Meclomen, Motrin, Feldene, Orudis, Butazolidin and Phenylbutazone. Do not change or stop taking any medication unless instructed to do so by your internist, family physician or surgeon. Minor Surgical Procedures and Dental Care Do not schedule minor surgical procedures such as urological manipulators or exams or dental procedures such as teeth cleaning, cavity repairs or oral surgery within two weeks of your scheduled surgery. Sore Throats, Cold and Flu If you develop a cold, sore throat or the flu within one week of your scheduled procedure, please call your surgeon. These conditions may increase the operative and anesthetic risks, and your procedure may need to be rescheduled. Urinary Tract Infections If you develop a urinary tract infection within two weeks of your scheduled procedure, contact your family physician or urologist for treatment and notify your surgeon. This condition may increase the risk of a postoperative infection, and your procedure may need to be rescheduled. Pregnancy Elective ankle surgery is rarely indicated during pregnancy. If you become pregnant prior to your scheduled surgery, contact your surgeon so that your surgery can be rescheduled. Dentures and Contact Lenses Contact lenses, dentures and plates cannot be worn in the operating room. Be sure to bring your container and solutions to keep these devices protected while you are in surgery. Clothing Remember to bring comfortable, loose fitting bed clothing. A robe and slippers are recommended. Daily Showers and Skin Cleaning It is recommended that you wash your ankle, foot and toes with either PhisoHex or Dial soap for three or four days prior to admission. Be very careful that you do not nick your skin in the region of your ankle and if you have any breaks in the skin, contact your surgeon before going to the hospital. Length of Stay The normal length of stay for ankle replacement surgery is two days, although it may vary depending upon your condition. What to Bring to the Hospital
What to Expect Prior to Surgery
The Recovery Room When the procedure is completed, your surgeon will contact your family and friends to update them on your surgery. You will awaken after surgery in the post-anesthesia recovery room, probably feeling as though you were only away from your hospital room for a few minutes. You will remain there for an hour or so, or until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. If you have pain, the nurses will administer medication. Your ankle will be in a splint so you will not be able to move it. What to Expect After Surgery Your foot and lower leg will be elevated and immobilized in a splint, so you will not be able to move your ankle. Frequently, blood will be visible on the dressing and should not be cause for alarm. This is common and usually stops after a few hours. The first day after surgery, you will probably be allowed to get out of bed, sit in a chair and, on occasion, start physical therapy. The dressing is normally removed two days after surgery and movement of your ankle is started in physical therapy. To prevent nausea immediately after surgery, you will be given only ice chips or sips of water and soft drinks. The day after surgery, you will be allowed to have regular meals. An IV will normally remain in your arm for one or two days to administer antibiotics and fluids. This helps prevent infection and gives you proper nourishment until you are eating and drinking normally. It is normal to feel pain and discomfort after surgery. Be sure to inform your nurse of your pain and medication will be ordered. You may be able to administer your own pain medication through a push button attached to your bed. This system is called the "Patient Controlled Analgesia" (PCA). The nurses will show you how to use the system, which is designed to prevent overdose of pain medication. When the IV is discontinued, you will begin taking oral pain medication, but frequently pain medication is not necessary after the first day since the ankle is immobilized with a splint. The nurses will help you out of bed and into a chair on the day after surgery or possibly the afternoon of surgery. Two days after surgery, the ankle splint will be changed and you will begin gentle range of motion exercises. The physical therapist will instruct you on the safest method of getting in and out of a chair and will also determine which is the safest way for you to get around, either with a walker or crutches. Progress You will not be able to put weight on your ankle for the first six weeks, during which time you will be using crutches or a walker. Instructions on how to take the splint off twice a day to perform range of motion exercises will be given prior to your discharge. The sutures will be removed about two weeks after surgery. At Home Until you see your surgeon for your first follow-up visit, make certain that your wound stays dry and is not draining. If you do notice any drainage or foul odor from your incision, please contact your surgeon. Also, if your temperature goes over 100.4 degrees or you notice any increased swelling or tenderness, call your surgeon. Take time to adjust to your home environment - it's okay to take it easy. You may need help with your daily activities, so it is a good idea to have family and friends prepare to help you. It is normal to feel frustrated, but these frustrations will soon pass. Resuming Activities
You develop a cold, fever, sore throat, pulmonary (breathing) problems, cardiovascular (heart or circulation) problems or other general physical difficulties that cause you concern. Contact Your Surgeon If: You develop an increase in ankle pain, swelling, drainage, temperature or have any problems controlling motion of your ankle. Medication/Pain Control It is normal for you to have some discomfort, but it would be unusual for you to use pain medication more than five to seven days after surgery. You will receive a prescription for pain medication before you leave the hospital. If a refill is needed, please call your surgeon's nurse at least three days before you run out of pills. Special Instructions You will normally be seen six weeks and three months after surgery. A six-month exam is also usually scheduled for new x-rays and an assessment of your progress. Note for the Future You should always tell your dentist or physician that you have an artificial joint. If you are having dental work performed, notify your dentist or physician so he/she can prescribe antibiotics for the day before and the day of your dental care. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life. Any infection must be promptly treated with proper antibiotics because infection can spread from one area to others through the blood stream. Every effort must be made to prevent infection in your artificial joint. Your surgeon can give you instructions on the use of special antibiotics. Your Questions Answered Question:How long will I be in the hospital? Answer:Ankle replacement surgery usually requires hospitalization the day of surgery and two days after. Occasionally patients can go home one day after surgery; but, additional time may be necessary if you live alone or experience problems. Question:When will I be able to move my ankle? Answer:The splint is usually removed on the second day and movement of your ankle, up and down, is begun at that time. You will continue to use crutches or a walker with no weight bearing allowed on the affected side for six weeks following surgery. Disclaimer: This material does not constitute medical advice. It is intended for informational purposes only. NO ONE ASSOCIATED WITH DELMARVA ORTHOPAEDIC CLINIC WILL ANSWER MEDICAL QUESTIONS VIA EMAIL. Please schedule an appointment with one of our physicians for specific treatment recommendations. |
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