Foot and ankle surgery

Last updated
Foot and Ankle Surgeon
Occupation
Names Doctor, Surgeon
Activity sectors
Surgery
Description
Education required
M.D., D.O. or D.P.M.
Fields of
employment
Hospitals, Clinics, Surgery Centers

Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school or osteopathic medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics, and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school (D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship.

Contents

The distinction between a podiatric and orthopedic foot and ankle surgeon is: an orthopedic surgeon has a Doctor of Medicine or Doctor of Osteopathic Medicine medical degree or osteopathic medical degree and training that encompasses both orthopedic residency and an optional 6-month to one year of fellowship training specific in techniques of foot and ankle surgery, while the training of a Doctor of Podiatric Medicine consist of a podiatric medical degree and three to four-year residency training specific to foot and ankle medicine and surgery, [1] with an optional additional 1-year fellowship in foot and ankle trauma, reconstruction, or diabetic limb salvage.

In the UK much controversy exists on the scope of podiatrists practicing surgery and the British Orthopaedic Association, and the British Orthopaedic Foot and Ankle Society produced a position statement on the importance of training and ongoing regulation of podiatrists practising podiatric forefoot surgery after certification and recommended that this should be to the same standard as that of medically qualified trauma and orthopaedic surgeons operating on the foot and ankle. [2]

Clinical scope

Foot and ankle surgeons are trained to treat all disorders of the foot and ankle, both surgical and non-surgical. Additionally, the surgeons are also trained to understand the complex connections between disorders and deformities of the foot, ankle, knee, hip, and the spine. Therefore, the surgeon will typically see cases that vary from trauma (such as malleolar fractures, tibial pilon fractures, calcaneus fractures, navicular and midfoot injuries and metatarsal and phalangeal fractures.) Arthritis care (primarily surgical) of the ankle joint and the joints of the hindfoot (tarsals), midfoot (metatarsals) and forefoot (phalanges) also plays a rather significant role. Congenital and acquired deformities include adult acquired flatfoot, non-neuromuscular foot deformity, diabetic foot disorders, hallux valgus and several common pediatric foot and ankle conditions (such as clubfoot, flat feet, tarsal coalitions, etc.) Patients may also be referred to a foot and ankle surgeon for proper diagnosis and treatment of heel pain (such as a consequence from plantar heel fasciitis), nerve disorders (such as tarsal tunnel syndrome) and tumors of the foot and ankle. Amputation and ankle arthroscopy (the use of a laparoscope in foot and ankle surgical procedures) have emerged as prominent tools in foot and ankle care. In addition, more applications for laser surgery are being found in the treatment of foot and ankle disorders, [3] including treatment for bunions [4] and soft tissue lesions. A patient may also be referred to a foot and ankle surgeon for the surgical care of nail problems and phalangeal deformities (such as bunions and bunionettes.)

Non-surgical treatments

The vast majority of foot and ankle conditions do not require surgical intervention. For example, several phalangeal conditions may be traced to the type of foot box used in a shoe, and a change of a shoe or shoe box may be sufficient to treat the condition. For inflammatory processes such as rheumatoid arthritis, non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDS) may be used to manage or slow down the process. Orthotics, or an externally applied device used to modify the structural or functional characteristics of the neuromusculoskeletal system specifically for the foot and ankle, may be used as inserts into shoes to displace regions of the foot for more balanced, comfortable or therapeutic placements of the foot. Physical therapy may also be used to alleviate symptoms, strengthening muscles such as the gastrocnemius muscle (which in turn will pull on the heel, which will then pull on the plantar fascia, thus changing the structure and shape of the foot).[ by whom? ]

Surgical treatments

Anterior and lateral view x-rays of fractured left leg with internal fixation after surgery X ray internal fixation leg fracture.jpg
Anterior and lateral view x-rays of fractured left leg with internal fixation after surgery

Surgery is considered to be a last option when more conservative approaches fail to alleviate symptoms. Techniques such as bunionectomies may be used to surgically remove bunions and other foot and ankle deformalities, arthrodesis (or fusion of joint spaces) for inflammatory processes, and surgical reconstruction (i.e. invasive measures of manipulating neuromusculoskeletal structures) to treat other deformalities. Orthotics, physical therapy, NSAIDs, DMARDs and a change of shoe may act as a complement to surgical intervention, and in most cases will be required for optimal recovery.

Publications

The last 50 years has shown high quality research into the etiology and management of foot and ankle deformities. Several publications have been made to act as forums for such research:

See also

Related Research Articles

Bunion Deformity characterized by lateral deviation of the big toe

A bunion, also known as hallux valgus, is a deformity of the joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complications may include bursitis or arthritis.

A podiatrist is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine. The word chiropodist was previously used in the United States, but it is now regarded as antiquated.

Orthopedic surgery Branch of surgery concerned with the musculoskeletal and bones system

Orthopedic surgery or orthopedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

Podiatry Medicine branch focusing on human lower extremities

Podiatry or podiatric medicine is a branch of medicine devoted to the study, diagnosis, and medical and surgical treatment of disorders of the foot, ankle, and lower extremity. The term podiatry came into use in the early 20th century in the United States and is now used worldwide, including in countries such as the United Kingdom, Australia, and Canada.

Plantar fasciitis Connective tissue disorder of the heel

Plantar fasciitis is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually, and it affects both feet in about one-third of cases.

Diseases of the foot

Diseases of the foot generally are not limited, that is they are related to or manifest elsewhere in the body. However, the foot is often the first place some of these diseases or a sign or symptom of others appear. This is because of the foot's distance from the central circulation, the heart and its constant exposure to pressures from the ground and the weight of the body.

Hammer toe Medical condition

A hammer toe or contracted toe is a deformity of the muscles and ligaments of the proximal interphalangeal joint of the second, third, fourth, or fifth toe causing it to be bent, resembling a hammer. In the early stage a flexible hammertoe is movable at the joints; a rigid hammertoe joint cannot be moved and usually requires surgery.

Lisfranc injury Type of fracture/dislocation injury of the foot

A Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus.

Hugh Owen Thomas

Hugh Owen Thomas was a Welsh orthopaedic surgeon. He and his nephew Robert Jones have been called "the Fathers of orthopaedic surgery".

Tailors bunion Medical condition

Tailor's bunion is a condition caused as a result of inflammation of the fifth metatarsal bone at the base of the little toe.

The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by Ignacio V. Ponseti of the University of Iowa Hospitals and Clinics, USA in the 1950s, and was repopularized in 2000 by John Herzenberg in the US and Europe and in Africa by NHS surgeon Steve Mannion. It is a standard treatment for clubfoot.

Unlike the flexible flat foot that is commonly encountered in young children, congenital vertical talus is characterized by presence of a very rigid foot deformity. The foot deformity in congenital vertical talus consists of various components, namely a prominent calcaneus caused by the ankle equines or plantar flexion, a convex and rounded sole of the foot caused by prominence of the head of the talus, and a dorsiflexion and abduction of the forefoot and midfoot on the hindfoot. It gets its name from the foot's resemblance to the bottom of a rocking chair. There are two subcategories of congenital vertical talus namely idiopathic or isolated type and non-idiopathic type which may be seen in association with arthrogryposis multiplex congenital, genetic syndromes and other neuromuscular disorders.

Robert S. Biscup is an American orthopaedic surgeon.

Dynasplint Systems

Dynasplint Systems, Incorporated (DSI) is a company that designs, manufactures and sells dynamic splints that are used for range of motion rehabilitation. The corporate headquarters are located in Severna Park, Maryland and it is considered a major employer in Anne Arundel County. Products are Made in the USA in Stevensville, Maryland. There is a national sales force throughout the US as well as a presence in Canada and Europe.

American Osteopathic Board of Orthopedic Surgery

The American Osteopathic Board of Orthopedic Surgery (AOBOS) is an organization that provides board certification to qualified Doctors of Osteopathic Medicine (D.O.) who specialize in the medical and surgical treatment of disorders of the musculoskeletal system. The board is one of 18 medical specialty certifying boards of the American Osteopathic Association Bureau of Osteopathic Specialists approved by the American Osteopathic Association (AOA), and was originally a subdivision of the American Osteopathic Board of Surgery until it became an independent board in 1978. As of December 2011, 1,082 osteopathic orthopedic surgeons held active certification with the AOBOS. Additionally, diplomates of the American Osteopathic Board of Orthopedic Surgery are eligible for membership in the American Society for Surgery of the Hand and the American Academy of Orthopaedic Surgeons.

Michael H. Wynn American podiatrist (born 1953)

Michael H. Wynn, D.P.M. is an American podiatrist practicing in Kingwood, Texas, specializing in surgical application of lasers in the treatment of foot and ankle disorders. He has helped pioneer the treatment of bunions with the CO2 laser.

Syndesmosis procedure

Syndesmosis procedure is one of the more than 20 bunion surgeries currently being performed. While the majority of bunion surgeries involve the breaking and shifting of bones, syndesmosis procedure is one of few surgical techniques that use a soft tissue or non-osteotomy (non-bone-breaking) approach to afford the same correction. More than 130 different surgical techniques have been described for correction of one single condition of the foot: the bunion deformity.

The following outline is provided as an overview of and topical guide to trauma and orthopaedics:

Philip Radovic, D.P.M. is a professor and practicing podiatric surgeon in South Orange County California.

Treace Medical Concepts, Inc. is a medical device company, headquartered in Ponte Vedra Beach, Florida, specializing in the design, manufacture, and marketing of foot and ankle surgical devices and biologics. Lapiplasty, Treace’s novel primary surgical product, advanced the treatment of bunions, surgically correcting the metatarsal bone, for the first time, in all three dimensions.

References

  1. "Archived copy" (PDF). Archived from the original (PDF) on 2011-09-29. Retrieved 2011-08-28.{{cite web}}: CS1 maint: archived copy as title (link)
  2. "British Orthopaedic Association" (PDF).
  3. Kaplan M.D., Isaac (February 1989). "Fifteen Years' Experience with the CO2 Laser". In Ballow D.P.M., Edward B. (ed.). Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 55–64.
  4. Wynn D.P.M., Michael H. (October 1986). "Soft-Tissue Bunion Repair with a CO2 Surgical Laser". The Journal of Current Podiatric Medicine. 35 (10): 27–28.
  5. The Foot & Ankle Journal