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What is Post-Traumatic Reconstruction of the Foot and Ankle?

Post-traumatic reconstruction of the foot and ankle is a surgical procedure performed for the correction of foot and ankle deformities as a result of traumatic injury and to restore lost function. It may include osteotomy (cutting and reshaping of bone), bone grafting, tendon transfers, soft tissue repair, joint implantation, and arthrodesis (fusions of bones at joints).

Trauma to the foot and ankle can damage muscles, ligaments, tendons, and bones, resulting in significant pain, disability, and wearing of joint cartilage (arthritis). Reconstructive surgery is done to reduce pain, prevent further deformity, and restore stability, appearance, and function of the foot and ankle.

Anatomy

The foot and ankle are complex joints involved in movement and providing stability and balance to the body. They are flexible structures made of soft tissues, muscles, bones, and joints. The foot is usually differentiated into 3 parts: the forefoot, comprising 5 toes, the midfoot, comprising 5 bones that form the arch of the foot, and the hindfoot, forming the heel and ankle. The ankle is a large joint made up of 3 bones: the tibia, fibula, and talus. Ligaments and tendons run along the surface of the feet, promoting easy and flexible movement.

Indications for Post-Traumatic Reconstruction of the Foot and Ankle

Post-traumatic reconstruction of the foot and ankle is indicated for conditions such as:

  • Fractures and dislocations sustained as a result of motor vehicle accident/trauma
  • Athletic injuries like Achilles tendon tears, foot/ankle fractures, ligament injuries, and several others
  • Joint or bone deformities due to post-traumatic arthritis
  • Crushing injury
  • Gunshot wound
  • Fall from a height
  • Other sources of physical trauma

Preparation for Post-Traumatic Reconstruction of the Foot and Ankle

Preoperative preparation for post-traumatic reconstruction of the foot and ankle may involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements you are taking.
  • You may need to stop taking supplements or medications such as blood-thinners or anti-inflammatories for a week or two prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to surgery.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Post-Traumatic Reconstruction of the Foot and Ankle

Post-traumatic reconstructive surgery of the foot and ankle can be performed through either an open or arthroscopic approach under regional or general anesthesia. The surgery to be performed depends on several factors such as the age of the individual and severity and type of injury.

In an arthroscopic surgery, tiny incisions (portals), about a half-inch in length, are made around the foot or ankle. Through one of the incisions, an arthroscope - a small flexible tube with a light and video camera at the end - is passed into the treatment area. The camera displays images of the inside of the treatment area on a monitor, allowing your surgeon to view the damage and carry out the required repair.

In an open surgery, a long incision of several centimeters is made over the foot or ankle. The underlying soft tissues are carefully moved aside to expose the treatment area. Special surgical tools are used to carry out the required repair. Once the repair is complete, the instruments are removed, and the incisions are closed with stitches or small sterile bandage strips.

In general, reconstructive foot and ankle surgery may involve:

  • Complete debridement of the treatment area (removal of dead tissue and foreign bodies)
  • Reduction (realignment of broken bones) and external fixation of broken bones (using pins, plates, staples, screws, or casts).
  • Injuries to the forefoot may be treated with skin flaps and amputation of toes.
  • Midfoot injuries may necessitate an antibiotic spacer (a device positioned within a joint to maintain joint space and alignment), external fixation, covering of soft tissue injuries, and arthrodesis.
  • Hindfoot injuries involving the heel and ankle are tough to treat and necessitate early reduction and fixation of fracture fragments, followed by arthrodesis. Fusion is restricted to selective joints to decrease stress and ameliorate overall foot function. Bone grafting may be performed in cases of substantial bone loss.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after post-traumatic reconstruction of the foot and ankle may involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • You may notice pain and swelling in the treatment area. Medications are provided as needed to address these.
  • Antibiotics are also prescribed to address the risk of surgery-related infection.
  • You may apply ice bags over a towel to the affected area for 15-20 minutes to reduce postoperative pain and swelling.
  • Do not weight-bear on the operated leg. A walking boot or a non-weight-bearing cast is recommended for a few weeks to facilitate healing and support the foot.
  • Assistive devices such as crutches and walkers are recommended to maintain balance and stability while walking for several weeks.
  • Keep the foot elevated at or above the level of your heart to help minimize swelling and discomfort.
  • Start rehabilitation (physical therapy) as recommended by your surgeon to improve range of motion. You should begin appropriate exercises to stretch and strengthen the foot/ankle muscles.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • Refrain from strenuous activities and lifting heavy weights for at least 6 months. Gradual increase in activities is recommended, with your doctor’s guidance.
  • Return to sports is recommended only when the foot has regained its normal strength and function, and with your doctor’s approval.
  • Full recovery from surgery may take about 6 to 12 months, based on the type of reconstructive surgery performed.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Post-traumatic reconstruction of the foot and ankle is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Bleeding
  • Postoperative pain
  • Damage to nerves and vessels
  • Thromboembolism or blood clots (DVT)
  • Anesthetic/allergic reactions
  • Non-union of bones
  • Failure of fixation devices
  • Failure of grafts or flaps
  • The Arthroscopy Association of North America
  • The American Osteopathic Academy of Orthopedics (AOAO)
  • The American Academy of Orthopaedic Surgeons
  • American Orthopaedic Foot & Ankle Society┬«
    Orthopaedic Foot & Ankle Foundation
  • American Academy of Osteopathy
  • American Osteopathic Association