Ankle Joint Arthroplasty

Sounds like the science of ankle joint arthroplasty is starting to heat up a bit. Ankle joint arthroplasty? What’s that? Arthroplasty means to remodel. And in most cases, we’re talking about post traumatic arthritis or osteoarthritis.

So what’s new? Well, for years, the gold standard has been ankle fusion. And that’s the procedure that old guys like me (twenty five years in practice) still use on a regular basis. From the standpoint of outcomes, I tend to find that ankle fusion has a good, functional outcome. For most folks, when walking, you don’t even have a perceptible limp post fusion.

One new technique is called arthrodiastasis. Arthrodiastasis involves the application of an ankle distractor. The distractor is placed with two pins in the foot and one in the leg. Then the pins in the foot and leg are separated to ‘off-load’ the ankle. The idea here is that the ankle will be able to return to a normal joint and regenerate cartilage. Problems with arthrodiastasis include surgery (pins in the leg), pin tract infections and a bit of a ‘keep your fingers crossed’ approach to the ankle. Most studies describe a 2-5 month need for the ankle distractor and non-weight bearing. Long terms results on arthrodiastasis are pending.

Daniel Lee, DPM just came out with a novel a procedure in the Sept/Oct ‘08 J of Foot and Ankle Surgery (47:5, 2008). Lee describes a technique where he employs arthrodiastasis in conjunction with the use of Graft Jacket. Graft Jacket is used as a fibrous scaffold for cartilaginous in-growth. Again, long term studies are pending.

And ankle implants? That’s another hot topic. What’s my choice? I still haven’t warmed up to the use of ankle implants. Many of the cases that I see involve patients who are not happy with their ankle implants. I’m sure there are many who have had success. But for now, I’m sticking to ankle fusion.

Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
The Foot Talk Forum

Searching for foot and ankle information and products

Search can seem like a never ending quest. Here’s a tip for searching Myfootshop.com when you’re searching for foot and ankle information and/or products.

First, go to Google. In the Google search box, type in site:www.myfootshop.com. That query will give you every indexed page for Myfootshop.com.

Want to get a bit more specific? Just add a more specific search term to the query above. Try this refined search; in the Google search box type in ’site:www.myfootshop.com bunion’ or ’site:www.myfootshop.com hallux limitus’.

The beauty of this kind of search is that your search return will include every bit of foot and ankle information on Myfootshop.com related to your search term. Results will include all forum posts, conditions pages and products.

Jeff
Myfootshop.com

Great toe implant arthroplasty vs fusion – which is best?

I’ve been an implant guy for years. Implant arthroplasty (Mayo-Keller bunionectomy) is simply what I learned to use in my residency training 25 years ago. In cases of stage 4 hallux limitus (HL), I’ll opt for a great toe implant over a fusion any day. My logic is that it’s simple; what I would want to have. I’d like to maintain my range of motion of the great toe joint.

I’ve watched with interest as the podiatry community seems to have followed the orthopedics community into a trend to fuse stage 4 HL. Fusion has long been the procedure of choice in orthopedics.

But I was heartened by several articles in The Journal of Foot and Ankle Surgery this year that have been advocating the use of implants in cases of stage 4 HL. Ironically, some were written by orthopedists (JFAS is a publication of the American College of Foot and Ankle Surgeons – the academic branch of podiatric surgery).

Sure, there are indications for great toe joint fusions, but I just can’t see using it on a regular basis when the use of an implant is a reasonable and reliable choice. Heck, foot and ankle surgeons are all gun-ho on doing ankle joint replacements. Why not the same emphasis on great toe implant arthroplasty.

Bottom line is the procedure works. Why fuse the joint?

Jeff
Jeffrey Oster, DPM
Medical Director
Myfootshop.com

Partial rupture of the Achilles tendon – when to return to activity?

Partial rupture of the Achilles tendon is often diagnosed by a thick swelling found in the tendon.  The most common location for this injury is several centimeters above the insertion of the tendon into the back of the heel.  Partial rupture of the tendon is often a red flag for a complete rupture of the tendon.  Many doctors will caution you to limit your activities to prevent a complete rupture of the tendon.

How do you know how much or how aggressive an activity would be reasonable in light of a partial tear?  What kind of activity will put you at risk for a complete rupture?  Join us in our discussion forum for this conversation on partial Achilles tendon ruptures.

Jeffrey Oster, DPM
Medical Director
Myfootshop.com