Arthroscopy about the foot and ankle
|
|
|
Arthroscopy is a special
tool to secure diagnosis and to facilitate the treatment of joint diseases as
an alternative to or combined with "open" assessments and other surgical means.
This technique addresses selected diseases affecting the large joints of the
hindfoot.
|
Ligament reconstruction about the foot and ankle
|
| Ankle sprain is the most frequent traumatic lesion about the whole human body. With the development of surgery, it became very common to operate on these cases and suture the torn ligaments. In recent decades, however, it has been shown repeatedly that healing and long term results are not improved by operative intervention. It is our opinion that, the vast majority of ankle sprains are best treated by immobilization of the hindfoot in a favorable position for about 6 weeks, the time for sound scarring of the torn ligaments and that surgical reconstructions after fresh trauma are only indicated in very rare cases. |
| Foot and ankle deformities | ||||||||||||||||||||||||||||||||||
|
Considering the functions of transmission of load and propulsion, the mechanical axes of
the foot and ankle are of primary importance for proper function. By deformity
we mean all alterations of these axes due to disease or trauma. Deformity may
thus imply structural bone axes and/or functional joint axes. Deformities may
thus be evaluated objectively, especially under weight-bearing conditions. We
consider the appearance and shape of the foot to be at least as important as
the radiological assessment. Deformities about the foot and ankle may be present at birth or develop in childhood (developmental), degenerative (with age, arthrosis), associated with neurological diseases due to a dysbalance of muscles and tendons,post-traumatic (following fractures or dislocations), linked with other diseases: inflammatory such as rheumatoid arthritis , or metabolic such as diabetes or caused by tumors. The foot presents twenty-eight bones: a lot when compared to the four bones which link the pelvis to the foot. Correcting deformities of the foot requires a thorough knowledge of anatomy and the function of bones, joints and the local musculature. Efficiency of the hand relies on highly mobile joints but the forces involved are low. In contrast, optimal function of the foot relies on less mobile joints subjected to high forces due to gravity and the transmission of kinetic energy. Therefore, correction procedures about the foot and ankle include bone cuts (osteotomies), joint fusions or releases and transfers of muscle tendons. Developmental (congenital) deformitiesThe prototype of developmental deformities is the "club foot", scientifically called "congenital talipes equinovarus". In this pathology, the multiplicity of bones and joints about the foot become evident. It is in fact a tridimensional deformity in which not only the joint axes are malpositioned but also the bones are deformed. Especially if rigid, the treatment of this deformity is primarily surgical. It is mandatory that the foot that was deformed in utero achieves plantigrade posture under normal weight-bearing conditions at the usual age of walking. The origins of the disease are multiple and the severity of expression of the deformity is very variable. Degenerative deformitiesDegenerative deformities may be due to an "invisible" developmental disease or weakness, or constant overload of the limb. Flat feet and hallux valgus are not to be considered as diseases in themselves because there are millions of people in the world who walk throughout their life with these morphological "characteristics" and who never will experience any discomfort or pain. On the other hand, flat feet and hallux valgus may be associated with or part of the expression of degenerative disease including pain and discomfort and then they can be successfully treated by orthopaedic surgical means without fear of recurrence and without functional limitations.
Neurological diseasesNeurological dieseases can have a significant impact on foot deformities in childhood as well as in adults. The motors behind foot function are muscles which have their origin within the lower leg. Overpower or lack of muscular function may have a neurological origin which itself cannot be cured. Transfer of tendons about the foot is, for example, an important tool in the correction of these deformities. Post-traumatic deformitiesFractures or fracture-dislocations, if not treated, may consolidate with a considerable deformation of the affected bones. Within the foot, this might result in painful joint arthritis or, more correctly, "arthrosis". This means that the impaired joint undergoes destruction of its cartilage and painful stiffness results. Within the foot, anatomical bone and joint axes are mandatory for free function. In cases of deformation following "malunited" fractures, reconstructing the foot and ankle axes together with joint fusions might be the key to painfree motion of essential joints. Rheumatoid arthritisThis disease progressively destroys all joints by chronic inflammation. In fact, more than half of all patients with polyarthritis experienced the onset of the disease in their feet. Treatment, which is long and tiresome, is generally guided by a rheumatologist, but in many cases, operative joint replacement may be indicated using endoprostheses. Within the foot, such joint replacement is, in selected cases, beneficial for the ankle joint. In our opinion, other joint replacements are not indicated for the foot and ankle. Diabetes mellitusDiabetes or more precisely: "diabetes mellitus" not only means that there is too much sugar in the blood. This disease is also known to cause harm to arteries and nerves. The arteries and nerves are not affected constantly but must be assessed precisely. In the end, the diabetic person cannot feel his feet anymore "internally" and overloads his weight-bearing bone and joints. The complex skeleton of the foot then often collapses and the resulting deformity causes local abnormal pressure of the plantar skin which fails too, thus creating a wound which will never close spontaneously. Conventional, non-operative treatment may be long and demanding, including special shoe wear, constant podiatric controls. Limb-saving surgery include operative correction of the deformity. In selected cases, such correction of the deformity includes joint fusions even in the presence of open wounds. TumorsTumors are rare within the foot and ankle area when compared to the rest of the body. There are benign tumors and pseudotumors (which do not imply anarchic cell growth) and malign tumors which are either of primary origin within the foot and ankle or secondary layers of a tumor located elsewhere within the body. The frequently encountered so-called "Morton's neuroma" is a pseudotumor. |
Prescription of foot orthoses
|
| In some selected cases, an insole or orthosis can be a relief from pain, especially for those with a delicate plantar skin constitution. They also may provide a strong mechanical support in some muscular deficiencies. All diabetics should, in our opinion, use them once the diagnosis is certain since plantar orthoses avoid peak loads occurring at the plant of the foot. |
Teaching means
|
|
Courses: (* on invitation) *K.Klaue (Chair) *J Bartonicek, H.Zwipp, K.Klaue, ST Hansen (Chair) *K.Klaue, (Org, Chair) *K.Klaue (Chair) *K.Klaue (Chair) *K.Klaue (Chair) *K.Klaue (Chair) *K.Klaue *K.Klaue (Chair) *K.Klaue (Chair) *K.Klaue (org) *K.Klaue, (Chair) *K.Klaue, (Chair) *D.Höntzsch, K.Klaue, K.-M.Stürmer *K.Klaue, J. Quintero (Chair) Sektion: Klinische Diagnostik; Referate des Fusskurses im Rahmen der DGU-meeting KURS D6;Verletzungen des Fusses (II) session 14 61. Annual meeting of the Deutsche Gesellschaft für Unfallchirurgie (DGU) e.V., ICC Berlin 14-17.11.2001 K. Klaue: Presentation of
the Pilon Plate (FAEG) *K. Klaue (Chair) *K. Klaue (Chair) *K. Klaue, (org.) K. Klaue (org) *K.Klaue (Chair) *K. Klaue *K.Klaue (org.) (with H.Zwipp, S.T.Hansen jun.) *K.Klaue (Chair) A.C.Masquelet and K.Klaue (org). * K.Klaue, H.G.Hermichen, J.V.Wening (Chair) * K.Klaue, P.Laing (Chair) * K.Klaue, R.Viladot (Chair) *K.Klaue (Chair) *K.Klaue, H.Zwipp (Chair) *K.Klaue (chair) K.Klaue (org.) * H.Mailänder, K.Klaue (Chair) *K.Klaue, A.Mariakakis (Org.) *K.Klaue (Chair) * K. Klaue (Chair) *K. Klaue (Chair) *K. Klaue, B. Noesberger (org.) *K. Klaue (org.) Demonstrations: K.Klaue: Clinical demonstration operation of one case of calcaneal
fracture. Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik
für Unfall- und Wiederherstellungschirurgie, Dresden, Oct. 9th
2003 (CD Rom DVD) K.Klaue, P.Cronier Open reduction
and internal fixation of severe pilon fractures. Teaching tape for AO-ASIF
Courses, Nov. 2006 (english) K.Klaue Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Dresden (D). Oct. 9th 2003 live transmission of: Reduction and internal fixation of a calcaneal fracture, anterior process. K.Klaue Fibular Malunion after Malleolar Fractures. Correction Osteotomy. B.G.Weber’s technique, March 2003 (english) K.Klaue Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Dresden (D). Oct. 10th 2002 live transmission of: Reduction and internal fixation of a Chopart Fracture dislocation K.Klaue Subtalar Reorientation Arthrodesis. Teaching tape for AO-ASIF Courses, Aug. 2002 (english) K.Klaue Open Reduction and Internal Fixation of Distal Intraarticular Tibia Fractures. Teaching tape for AO-ASIF Courses, Aug. 2002 (english) K.Klaue Ankle arthrodesis. The postero-lateral approach. . Teaching tape for AO-ASIF Courses Oct. 2000 (english) K.Klaue, R.Dotti: Open reduction and internal fixation of talus fractures. Teaching tape for AO-ASIF Courses Oct. 1998 (english) K.Klaue, H.Zwipp: Open reduction and internal fixation of comminuted calcaneal fractures. Teaching tape for AO-ASIF Courses Oct. 1996 (english-Deutsch) K.Klaue: Convention Center Davos / Hospital Davos / AO Research Institute Davos Switzerland, June 9th 1995 live transmission of: Achilles Tendon plasty using FHL K. Klaue: Arthrodèse cunéo-métatarsienne pour
Hallux Valgus |
| ::: previous page ::: | ::: Home Page ::: | ::: contact me ::: |
| We do not inherit the earth from our ancestors, we borrow it from our children. (Antoine de Saint-Exupéry) | ||