Surgery of Hindfoot and Ankle Deformities

There are several problems of the rear foot and ankle that requires surgical intervention. The most common surgeries are Achille’s tendon repair, excision of calcaneal spur, subtlalar joint fusion, and ankle fusion. The problems of the rear foot and ankle can be treated with conservative therapy but if this treatment plan fails then surgical intervention will be considered.

Achille’s tendon trauma usually occurs in males between the ages of thirty to forty, that participate in intermittent sporting activities. The “weekend warrior” has a high chance of suffering an Achille’s tendon tear since the structures of the foot are not accustomed to high impact sports. Surgical correction of the tendon is completed by making a small incision to the back of the Achille’s tendon and suturing together the torn tendon. This procedure requires a healing time of six to eight weeks and will require at least six weeks of non-weight bearing to the affected limb.

A calcaneal spur is a a painful condition of the posterior heel where extra bone forms abnormally and causes pain. This extra bone is painful upon palpation and will sometimes involve the Achille’s tendon. The procedure to fix this problem requires shaving the boney prominence from the heel bone and possibly reattaching the Achille’s tendon if it is involved.

Arthritis of the subtalar and ankle joint is quite common if there is a history of trauma. Chronic ankle sprains or ankle fractures can cause damage to the joints therefore resulting in painful arthritic joints in the future. The definitive way to resolve the joint pain caused by previous trauma is stopping the motion of the joint by fusion. The subtalar joint and ankle joint both have their important roles in the gait cycle but when persistent chronic pain occurs and does not allow for proper motion a fusion of these joints can help regain functionality of the foot and ankle. The fusion of these joints requires resection of all the arthritic bone and cartilage and then placing screws across the joint to fuse the two bones together. This option is typically reserved for when all other conservative and surgical options have been exhausted.

Recovery times for all of these procedures can be very lengthy and require varied times of non-weight bearing. It may take up to one year for complete healing to occur. Physical therapy to rehabilitate the tendons and muscles after the period of non-weight bearing will be required as well.

Possible complications that can occur is malunion, nonunion, infection, and failure. Also, these surgeries can effect surrounding structures by placing more stress on them. Sometimes revision of the surgery is required if the bones or tendons heal in an abnormal way.

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