Arthroscopy, or keyhole surgery, is an invaluable tool in the treatment of the foot and ankle.
It was first developed for knee surgery in the 1960s. Small joint arthroscopy followed in the 1980s and as the technology and equipment improved, arthroscopy was adapted to the multiple foot and ankle joints by specialist orthopaedic surgeons.
Who needs Arthroscopic Surgery
Arthritic joint debridement
Arthroscopy is commonly performed to remove excessive scar tissue and redundant cartilage from the joint. These loose bodies are typically present following an injury or as a result of osteoarthritis, causing significant pain. Occasionally, there may be spurs of bone (osteophytes) at the front of the joint which jar at the front of the ankle during walking. These can also be removed, along with loose fragments of bone within the joint.
Arthroscopy following a sprain or injury
Arthroscopy of the ankle is often performed for chronic ankle symptoms following a sprain or injury and is usually performed as day-case surgery. In fact, injuries to the articular (the portion of the bone that is linked to another bones through an intervening joint of cartilage) surface of the ankle joint are relatively common following ankle sprain and whilst most do not require surgery, those that do, can now be treated with arthroscopic surgery.
A severe sprain may tear the ligaments of the ankle but it can also damage the smooth cartilage covering the joint surface of the bones. This is called an “osteochondral defect” (OCD). Consisting of pieces of cartilage and bone, it may become loose and is a cause of continuing ankle pain following a bad sprain. An arthroscopy may be performed to remove a loose OCD.
In the case of an osteochondral defect, arthroscopy and curretage (clearing and preparing the chipped surface) provide the best chances of recovery, with over 80% of patients reporting complete or significant relief.
If an intra articular problem is suspected as the cause for the symptoms, then an ankle arthroscopy (keyhole surgery) is indicated. Overall, ankle arthroscopy in the situation has very good results with the majority of people (more than 75%) having complete or significant relief.
Treating the ‘footballer’s ankle’
The so-called called ‘footballer’s ankle’, or anterior impingement, is most commonly found in people who have been involved in kicking sports. The problem is caused by a large ‘spur’ of bone at the front of the ankle, causing pain, particularly when the foot is extended. This spur can be removed very effectively using arthroscopic techniques.
This is performed to treat problems with the joint underneath the ankle joint and is performed through two incisions on the outside of the ankle. Occasionally it is performed through incisions at the back of the ankle. The sural nerve may rarely be injured which might leave a patch of numbness at the side of the hindfoot. This may be temporary but can rarely be permanent.
Metatarsophalangeal or ‘big toe’ Joint Arthroscopy
This is arthroscopy of the ‘big toe’ joint and is performed for damage to the articular cartilage (OCD). It is performed through 2 or 3 incisions around the joint. The digital nerves may rarely be injured which might leave a patch of numbness at the side of the big toe. This may be temporary but can rarely be permanent.
How does it work
The joint is visualised using a small (4.5 mm or 2.7 mm diameter) telescope (fibre optic camera) inserted through very small incisions called portals.
The surgeon can then see the joint on a high definition screen in theatre. Specialised miniature instruments are then introduced into the joint through another ‘keyhole’. These needle-thin instruments are operated by the surgeon using a foot pedal operating panel.
Keyhole techniques require a high level of surgical skill, operating in three dimensions, guided by a two dimensional image on screen.
Arthroscopy is applied in a variety of different ways to treat foot and ankle conditions. It is also used to diagnose problems, providing the surgeon with a clear picture of the small joints and structures from the inside of the foot and ankle.
Several important joints can be accessed and treated in a “key hole” fashion. These include the ankle joint, subtalar joint and other joints in the hindfoot. Even very small joints, such as the hallux metatarsophalangeal joint (joint at the base of the big toe), can be treated in this way for specific problems. Tendons can also now be accessed using this technique.
How long will it take to recover?
Recovery following arthroscopy (foot and ankle keyhole surgery)
- You can expect moderate discomfort for a few days
- You are encouraged to walk on the foot from the day of surgery
- You will be provided with exercises to begin straight away by the physiotherapist who will see you following surgery
- Crutches will be provided to assist you in walking initially
- The bandages can be removed at three days to leave the simple dressings (sticky plaster) which should not be removed until the stitches are removed at 10–14 days
- The wounds must be kept dry until the stitches are removed – showering /bathing still possible as long as dressings kept dry
- Return to office work usually possible at one week post surgery but this depends upon the particular demands of your job and your travel arrangements to and from work
- Driving is usually possible from one to two weeks following surgery, but you must ensure that the ankle is sufficiently comfortable for safe operation of the pedals. You should also inform your insurer before returning to driving. If in doubt wait until you are seen for removal of stitches before returning to driving.
- You can usually begin to return to sport once the stitches have been removed – gradually increasing your activity as your symptoms improve. Full return to sport would not be expected before six weeks following surgery
- Some swelling may persist in the ankle for up to three months post surgery although usually this has resolved by six weeks following surgery
The London Foot and Ankle Centre is one of the leading UK centres for foot and ankle arthroscopy. Our specialists are committed to using minimally invasive approaches when appropriate.