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Foot and ankle surgery

Foot and ankle surgery

Foot and ankle surgery

Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics, and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school (D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship.

The distinction between a podiatric and orthopedic foot and ankle surgeon is important: an orthopedic surgeon has a Doctor of Medicine or Doctor of Osteopathic Medicine medical degree and training that encompasses both orthopedic residency and an optional 6-month to one year of fellowship training specific in techniques of foot and ankle surgery, while the training of a Doctor of Podiatric Medicine consist of a podiatric medical degree and three to four-year residency training specific to foot and ankle medicine and surgery, with an optional additional 1-year fellowship in foot and ankle trauma, reconstruction, or diabetic limb salvage.

In the UK much controversy exists on the scope of podiatrists practicing surgery and the British Orthopaedic Association, and the British Orthopaedic Foot and Ankle Society produced a position statement on the importance of training and ongoing regulation of podiatrists practising podiatric forefoot surgery after certification and recommended that this should be to the same standard as that of medically qualified trauma and orthopaedic surgeons operating on the foot and ankle.

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Clinical scope

Foot and ankle surgeons are trained to treat all disorders of the foot and ankle, both surgical and non-surgical. Additionally, the surgeons are also trained to understand the complex connections between disorders and deformities of the foot, ankle, knee, hip, and the spine. Therefore, the surgeon will typically see cases that vary from trauma (such as malleolar fractures, tibial pilon fractures, calcaneus fractures, navicular and midfoot injuries and metatarsal and phalangeal fractures.) Arthritis care (primarily surgical) of the ankle joint and the joints of the hindfoot (tarsals), midfoot (metatarsals) and forefoot (phalanges) also plays a rather significant role. Congenital and acquired deformities include adult acquired flatfoot, non-neuromuscular foot deformity, diabetic foot disorders, hallux valgus and several common pediatric foot and ankle conditions (such as clubfoot, flat feet, tarsal coalitions, etc.) Patients may also be referred to a foot and ankle surgeon for proper diagnosis and treatment of heel pain (such as a consequence from plantar heel fasciitis), nerve disorders (such as tarsal tunnel syndrome) and tumors of the foot and ankle. Amputation and ankle arthroscopy (the use of a laparoscope in foot and ankle surgical procedures) have emerged as prominent tools in foot and ankle care. In addition, more applications for laser surgery are being found in the treatment of foot and ankle disorders, including treatment for bunions and soft tissue lesions. A patient may also be referred to a foot and ankle surgeon for the surgical care of nail problems and phalangeal deformities (such as bunions and bunionettes.)

Non-surgical treatments

Surgical treatments

The vast majority of foot and ankle conditions do not require surgical intervention. For example, several phalangeal conditions may be traced to the type of foot box used in a shoe, and a change of a shoe or shoe box may be sufficient to treat the condition. For inflammatory processes such as rheumatoid arthritis, non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDS) may be used to manage or slow down the process. Orthotics, or an externally applied device used to modify the structural or functional characteristics of the neuromusculoskeletal system specifically for the foot and ankle, may be used as inserts into shoes to displace regions of the foot for more balanced, comfortable or therapeutic placements of the foot. Physical therapy may also be used to alleviate symptoms, strengthening muscles such as the gastrocnemius muscle (which in turn will pull on the heel, which will then pull on the plantar fascia, thus changing the structure and shape of the foot).

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Anterior and lateral view x-rays of fractured left leg with internal fixation after surgery

Surgery is considered to be a last option when more conservative approaches fail to alleviate symptoms. Techniques such as bunionectomies may be used to surgically remove bunions and other foot and ankle deformalities, arthrodesis (or fusion of joint spaces) for inflammatory processes, and surgical reconstruction (i.e. invasive measures of manipulating neuromusculoskeletal structures) to treat other deformalities. Orthotics, physical therapy, NSAIDs, DMARDs and a change of shoe may act as a complement to surgical intervention, and in most cases will be required for optimal recovery.

10 common question about Foot and ankle surgery

1What is a foot and ankle surgeon?
Foot and ankle orthopaedic surgeons are medical doctors (MD and DO) who specialize in the diagnosis, care, and treatment of patients with disorders of the musculoskeletal system of the foot and ankle. This includes the bones, joints, ligaments, muscles tendons, nerves, and skin.
2What is reconstructive foot surgery?
Reconstructive Surgery of the Foot. Foot reconstruction is a surgery performed to correct the structures of the foot and restore the natural functionality of the foot that has been lost due to injury or illness. ... Common foot ailments like bunions or hammertoes. Postural deformity such as severe flat feet.
3How long does foot surgery take to recover from?
Most healing occurs within the first several weeks after surgery, but it may take as long as three to six months, and sometimes more, depending on the procedure, before the injured area is strong enough to take on high-impact activities.
4What are the different types of ankle surgery?
Here are some of the most commonly performed ankle surgeries. Fracture repair. The most common reason for ankle surgery is to repair bones that have been fractured. ... Ankle arthroscopy. ... Ankle fusion. ... Ankle replacement. ... Ankle distraction arthroplasty.
5Do foot doctors do surgery?
They also have "DPM" (doctor of podiatric medicine) after their names instead of "MD" (medical doctor). Podiatrists can do surgery, reset broken bones, prescribe drugs, and order lab tests or X-rays. They often work closely with other specialists when a problem affects your feet or lower legs.
6How do I become a foot and ankle surgeon?
To become an ABOS certified orthopaedic foot and ankle surgeon, a medical provider must: Complete four years of general medical school. Complete a minimum of five years of orthopaedic surgery residency. Complete at least one year of subspecialty fellowship training.
7How long does ankle reconstruction surgery last?
A splint is applied until the swelling goes down, and after a few days, a cast is applied for three to four weeks. It will take anywhere from four to six weeks before weight should be placed on the ankle. In some cases, patients will wear a removable walking boot to help with the process.
8Can flat feet be corrected with surgery?
The goal of surgical correction is to improve alignment of the foot. This allows for more normal pressures during standing and walking. A combination of procedures is performed to repair the ligaments and tendons that support the arch. Bone cuts are often made to help restore the arch.
9Can you walk after foot surgery?
You cannot drive while you are wearing a cast or walker boot on the foot that you use to drive. Your surgeon or physiotherapist will tell you when the cast or boot is no longer needed. This might mean that you cannot drive for 10 to 12 weeks after surgery.
10Do I sleep with my walking boot on?
It is advised to sleep with one's walking boot on but with the straps loosened for optimal comfort. A helpful tip when sleeping with one's boot on is to surround the leg with pillows to make sure the injured foot is supported. This will also make it unlikely for one to displace their foot, leading to further injury.

1 Comment

  1. I liked that you explained that orthopedic surgeons are medically qualified, due to extensive training and school, to perform foot and ankle surgery. I would imagine that needing surgery on your foot or ankle would be a stressful situation. I would feel more confident and comfortable with receiving surgery now that I understand how knowledgeable and educated orthopaedic surgeons are.

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