Reconstruction of problems after fractures or trauma of the foot and ankle

Reconstruction after ankle fractures
In some scenarios an ankle fracture may have been realigned but this reduction may have been inadequate or lost after surgery. In this circumstance, surgery may be beneficial to realign the ankle in a more normal, anatomical position. If this is performed prior to the irregular surfaces of the ankle continuing to rub against each other the development of arthritis may be prevented. There are many surgical options that may accomplish these goals when necessary. One of these procedures involves “rebreaking” the ankle and fixing the bones so that the ankle joint will rest in a more appropriate position. This can be accomplished by the use of bone graft to lengthening and realign the bones if necessary. In other scenarios the entire tibia bone which is above the ankle joint requires a cutting of the bone (osteotomy) and is then secured with plates and screws to better realign the ankle joint. After these procedures, the recovery is similar to that after the initial treatment of an ankle fracture. If these procedures and not performed and ankle arthritis develops, ankle fusion or replacement may become necessary. The treatment options once arthritis are developed are often times much more limiting then the procedures that may reconstruct the ankle earlier, thus “saving” the ankle joint. Treatment with an orthopaedic foot and ankle specialist trained in treating these conditions prior to the development of arthritis is critical if the ankle has not been completely aligned initially to prevent long-term complications.

For more on this condition, also see:
Ankle fractures
Arthritis of the foot and ankle
Total ankle replacement
Arthroscopic minimally invasive ankle fusion (arthrodesis)
 

Reconstruction after hindfoot and heel bone fractures (talus, calcaneus)
Fractures of the talus or calcaneus (hindfoot bones beneath the ankle) can cause significant long-term problems. Some of these specifically include pain and stiffness. In some circumstances conservative treatment with bracing or steroid injections may be of benefit but long-term solutions are often surgical. For some patients with arthritis in the subtalar joint (joint below the ankle joint) significant improvement in pain relief and function can be achieved with a subtalar arthrodesis (fusion, or gluing together of this specific joint of the foot). In other patients, if arthritis of the subtalar joint has not already developed, other procedures may be applicable that preserve the normal joints of the foot and ankle.

After talus fractures or calcaneus fractures, the bone may have failed to heal together or healed incorrectly. In these scenarios, called nonunions or malunions, if the subtalar joint is still without significant abnormality, the bones may be rebroken and realigned possible with the use of bone graft and new screws or plates to realign the foot.

After talus fractures in particularly, a condition called avascular necrosis may develop. This is problem with the blood supply to the talus bone causing the bone to die and possible collapse. In some scenarios, a procedure to stimulate the bone to develop a new blood supply by making small drill holes in the bone or to transfer bone and tissue with a viable blood supply to stimulate healing may be beneficial.

These bones have complex, intricate relationships and as such, should be treated by an orthopaedic foot and ankle specialist experienced in treating such disorders. Dr. Vora has published and lectured on the reconstructive options after this conditions both locally and nationally.

For more on this condition, also see:
Talus fractures
Calcaneus fractures
Triple arthrodesis
Subtalar arthrodesis
Hindfoot arthrodesis
 

Reconstruction after midfoot fractures (Lisfranc injury)
After both subtle as well as complex injuries of the midfoot, surgery may be necessary to stabilize the bones and ligaments in this area. Even after appropriate surgical management surgery may be necessary due to the development of arthritis in this location. With non-surgical management of unstable injuries, the development of painful arthritis of these joints is nearly universal. When pain has failed conservative treatment, surgery may be necessary. This specifically involved gluing the joints of the midfoot together (fusion) to prevent the minimal remaining motion and associated pain. This operation requires non-weight bearing for 8 weeks followed by protected increased weight bearing. The long term pain relief after such a procedure can be substantial and the limitations after this procedure involve stiffness across the middle of the foot. All of the up and down motion in the ankle persists and only the up and down motion contributed to the foot from these joints (less then 30% of the foot) is lost. For many patients with chronic undiagnosed pain in the middle of the foot in this region, a subtle injury that has occurred to this part of the foot that in commonly unrecognized may be the reason for the discomfort. Evaluation with an orthopaedic foot and ankle specialist may be necessary for diagnosis with specialized testing maneuvers and x-rays in order for appropriate recognition.

For more on this condition, also see:
Midfoot fractures
Midfoot arthrodesis