5 April, 2022
Minimally invasive surgery for foot and ankle injuries that do not respond to conservative treatment
Foot and ankle injuries are very common. Among athletes they occur regularly, but this type of injury can also be caused in daily life. In many cases, conservative treatment is enough to recover these injuries, but in a small percentage of cases this is not the case. The pain may persist and even the functionality of the joint may be affected. In these cases, surgery offers an alternative and in recent years, thanks to minimally invasive approaches, such as arthroscopy, greater comfort and better recovery of patients are being achieved.
SURGERY FOR SPRAINS THAT DO NOT IMPROVE
One of the most common when it comes to foot and ankle injuries is what is usually known as an ankle sprain, which is nothing more than a lateral ligament injury. In sports, this is one of the most common injuries and a frequent cause of consultation. “Conservative treatment is usually effective in most cases, but there is a group where the pain persists and there are even residual sequelae that translate into ankle instability”, explains Dr Daniel Poggio, orthopaedic surgeon who coordinates the Unit of Foot and Ankle of the Hospital Clínic and professional of barnaclínic+.
“In the face of an ankle sprain, conservative treatment is usually effective in most cases, but there is a group where the pain persists and there are even residual sequelae that translate into ankle instability”
Dr Daniel Poggio, orthopaedic surgeon who coordinates the Unit of Foot and Ankle of the Hospital Clínic and professional of barnaclínic+
In these cases, in which conservative treatment does not achieve a complete recovery from the ankle sprain, it is possible to opt for surgery to solve the problem. Specifically, an arthroscopy is performed, a minimally invasive surgical technique. A camera or arthroscope is inserted into it through small incisions, which allows the entire joint to be viewed completely, as well as the precise instruments to aspirate and illuminate the joint. This type of surgical technique offers more and better visualisation and manoeuvring solutions than open surgery and its complications are minimal, allowing a faster and better recovery for the patient.
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USE OF ENDOSCOPY FOR ACHILLES TENDON INJURIES
One of the main structures of the ankle is the Achilles tendon. It is the tendon that connects the calf muscle at the back of the leg to the heel bone. It is a tough band of fibrous tissue that allows the calf muscle to move the foot and is essential for walking, running, and jumping. It is the strongest and largest tendon in the body, allowing it to withstand the strain caused by movement and support the weight of the rest of the body.
“But although it is a very powerful tendon, when it is subjected to many forces, it is very common for an injury known as tendinopathy to occur or even to cause a rupture of the Achilles tendon”, adds Dr Daniel Poggio, who points out that in some tendon injuries it is necessary to resort to surgical techniques for recovery. Currently, they are performed through the use of endoscopy, consisting of inserting a camera or lens into a tube or endoscope, which in the case of these injuries is performed through a surgical incision. “Because this is a small incision, a quick recovery of the patient is possible”, continues Dr Poggio.
SURGERY FOR PLANTAR FASCIITIS PATIENTS
Another of the most common foot and ankle injuries that occur in the foot is plantar fasciitis. It consists of a stabbing and repetitive discomfort in the foot that is located especially in the heel. This pathology begins with the frequent microtraumas that occur during walking caused by an organised structure of connective tissue, called the plantar fascia, located on the sole of the foot, which extends from the heel to the base of the fingers.
In athletes who engage in intense physical activity whose feet suffer chronic microtrauma, it is a very common injury, but it can also be caused by a degenerative pathology of the elastic tissue of the sole of the foot. “Most patients manage to recover with conservative treatment, with stretching exercises and physiotherapy. However, there is a small percentage that does not improve and ends up needing surgery”, points out Dr Daniel Poggio.
“Most patients who suffer from plantar fasciitis manage to recover with conservative treatment, stretching exercises and physical therapy. However, there is a small percentage that does not improve and ends up needing surgery”
Dr Daniel Poggio, orthopaedic surgeon who coordinates the Unit of Foot and Ankle of the Hospital Clínic and professional of barnaclínic+
In these cases, the surgical option consists of performing a partial section of the plantar fascia to improve its length and thus reduce pain. Once again, this intervention is approached in a minimally invasive way, which allows the patient to be able to immediately support the foot after the operation and its performance is less risky.
