Over the last decades life expectancy has increased and will continue to do so in the future. Fortunately many people are staying fit and remain active at the later stages of life.
Whereas improved implants for the hips, knees and other parts of the muskulo-skeletal system have proven to be very beneficial there has been a lot less attention to pathologies affecting the foot and ankle. On the other hand, arthritis and malalignment of the ankle and foot have a huge impact on the lower limbs and subsequently on the quality of life.
Conservative treatment often can alleviate symptoms but at times only an operation will achieve the function and the pain relief that the patient is looking for.
Patient selection is very important and arranging pre op clinics and even more so the post op care is crucial for the elderly patients.
The ankle joint is the only joint in the hindfoot that can be replaced and with improved implant systems this has shown to be very successful. Other joints in the foot might benefit from a fusion (arthrodesis) which can eradicate pain, realign the foot and improve gait and function massively.
Sometimes pain is triggered more by a deformity within the foot than the degeneration of a joint and this can be corrected by joint preserving operations like osteotomies and soft tissue procedures.
Depending on the origin of the pathology a combination of procedures might be necessary to regain a pain free gait so that patients can remain active and have a high quality of life. Minimal invasive operations are particularly beneficial in the elderly generation as the soft tissue envelope left intact and reduces the risk of any wound healing problems. Recovery after minimal invasive operations may also be shortened.
The newer generation of ankle replacements has shown to provide very good pain relief, improve gait and function of the foot and allows a quicker recovery than a conventional fusion of the ankle joint. Survival rates of ankle joint replacements has also improved over the last decades and even mild to moderate deformities of the ankle and hindfoot are no longer a contra-indication for replacing a worn out ankle joint.
Martin Klinke is a Consultant Orthopaedic Surgeon at The London Foot and Ankle Centre. Established in 2003, the Centre was the first specialist service of its kind in the UK and it has developed into a centre of excellence for foot and ankle disorders.
