Treatment of the Foot and Ankle

Normal foot and ankle function is extremely important for us to be able to walk, run and jump. The foot and ankle are very complex structures consisting of 26 bones and 33 joints with multiple ligaments and tendons. Numerous conditions can affect the foot and ankle, including trauma and degenerative conditions. Most of these conditions can be treated. For some conditions surgery is the best treatment.

Dr Pretorius treats the following conditions of the foot and ankle:

Ankle:

  • Achilles tendon injuries and degenerative conditions.
  • Ankle fractures.
  • Ankle arthritis.
  • Cartilage injuries to the ankle including osteochondral lesions.
  • Ankle ligament injuries and recurrent ankle instability.

 

Foot:

  • Bunions.
  • Deformities of the toes including claw toes, hammertoes and planter
    plate injuries.
  • Arthritis of the foot.
  • Flat foot deformities not responding to inserts.
  • Sports injuries including turf toe, tendinitis and stress fractures.
  • Plantar fasciitis.
  • Ingrown toenails.
  • Diabetic foot conditions.

Diagnosis:

As many conditions affect the foot and ankle, Dr. Pretorius will take a thorough history, including your medical history and a list of medication. Examination will include examining your gait, range of motion of the foot and ankle joints, strength of ligaments and tendons as well as a neurovascular examination (to assess blood and nerve supply to the foot and ankle). You might need to have further tests done to confirm the diagnosis.

These tests may include:

  • Blood tests.
  • X-rays of the foot and ankle.
  • CT (Computed tomography) scan.
  • Magnetic resonance imaging (MRI).

 

Once a diagnosis has been established, Dr. Pretorius will discuss the proposed treatment in detail.

Treatment:

Non-operative treatment:

It is important to remember that conditions affecting the foot and ankle can often be treated without surgery. Most times, surgery will be considered only if nonsurgical treatments fail. This can include review by a podiatrist, change in footwear or special devices like arch supports, pads etc.

Surgical treatment:

Surgery of the foot and ankle is normally done in a hospital as a day procedure. Although some procedures can be done using local anaesthesia, most are performed under general anaesthesia. The appropriate anaesthesia will be discussed by your anaesthetist.

Serious complications following surgery are very uncommon, but surgical procedures carry some risks. Although extreme care is always taken to minimise any complications, there’s always a chance that it can occur and may have permanent effects.

General risks of surgery:

  • Risk of the anaesthetic.
  • Antibiotics are routinely used during surgery to prevent infection – some patients may have an allergic reaction or anaphylaxis.
  • Wound infection.
  • Bleeding in the wound with haematoma (big collection of blood) formation.
  • Pain / numbness around the incision.
  • Allergies to antiseptic solutions used to clean the surgical site.
  • Allergies to sutures and / or dressings
  • Deep vein thrombosis – there is always a risk of DVT with surgery of the lower limb.
  • Nausea and vomiting after surgery.

Specific Risks with Foot and Ankle Surgery:

Specific risks with foot and ankle surgery will largely depend on what surgery is performed. This will be discussed with you in detail by Dr Pretorius.

The risks may include the following:

  • Infection – Soft tissue infection in elective foot and ankle surgery is about 2%.
  • Injury to nerves.
  • Injury to blood vessels.
  • Blood clots in legs and rarely in lungs.
  • Non-union of fractures.
  • Non-union of joint fusion.
  • Re-rupture of tendon repairs / failure of healing of tendons.
  • Ongoing swelling in the leg.
  • Ongoing pain and stiffness.

Recovery after Foot and Ankle Surgery:

Following your foot / ankle surgery, you will wake up in the recovery room. The nurses in the recovery room will monitor your recovery by regularly checking your vital signs (pulse, blood pressure, etc).

The foot might be completely numb from the nerve block. It may take anything from 12-16 hours for the feeling to return.

Start taking pain medication as soon as the feeling returns, when the nerve block starts to wear off. It is better to stay in control and on top of the pain, by regularly using prescribed pain medication when needed.

Normally with foot surgery, you will not be able to put weight on the foot. You will be going home on crutches and should be familiar with the use of crutches. If not, please inform us.

If you are allowed to go home on the same day, it is important to arrange for somebody to collect you from the hospital and drive you home. It is illegal to operate a motor vehicle within 24 hours of having a general anaesthetic. If your surgery is overnight however, you will be transferred to the ward. Please arrange for someone pick you up the next day.

It is important to keep the foot elevated and to apply ice or cold packs to help with pain and swelling.

A physiotherapist will assist you in getting up and instruct you on how to use the crutches. This might happen on the same day as the surgery, depending on the time of your surgery.

A follow-up appointment will be arranged for you, usually for around 10 – 14 days after the surgery.

Try to only use the stronger pain medication when the more regular pain medication, like paracetamol, is not effective.

It is important to keep the surgical area clean and dry and to keep the wound dressings intact.

Recovery after surgery is different for every patient. The rehabilitation is as important as the surgery, if not more so. Your
cooperation and motivation are important to ensure effective recovery and an optimal outcome.

Please contact the surgery immediately if you have any of the following:

  • Any abnormal redness, swelling, bleeding or drainage from your incision site.
  • Any fever or chills.
  • Any increase in pain around the incision site.
  • Any pain in your calf or thigh with increased swelling in the leg.
  • Loss of movement or change in leg lengths
  • Any other concerns you may have.

 

Please find links to useful information regarding some surgeries:

 

And also, a link to a wonderful website with great animation videos and information on some of the procedures that are done:

https://www.orthoillustrated.com/ankle