Foot and ankle joint

The most common orthopedic injuries experienced by adult patients are fractures [1] and ankle injuries [2]. They can happen to everyone regardless of age, gender or lifestyle. However, the most vulnerable to injuries are athletes – approx. 30 percent of all injuries among people practising sports are those of the ankle [3].

Scientific studies have shown that approximately 30-40% of patients with ankle fractures develop degenerative ankle disease [4]. However, in almost 80% of people, the cause of arthrosis is post-traumatic changes [5].

Diagnostics of the ankle and foot

Diagnostics of the ankle or foot begins with a medical examination and an interview with the patient. The doctor checks the mobility of the joint, asking the patient to perform certain movements, e.g., to perform a plantarflexion. During the examination, the orthopedist also checks whether the patient’s foot may sustain loads. At the end of the examination, he performs clinical tests, e.g., the front drawer test.

An orthopedist may order imaging tests during a medical consultation, such as:

  • x-ray – to exclude or confirm an ankle fracture,
  • ultrasound – to assess ligaments and other soft tissues.

The doctor may also order a CT scan or MRI scan.

Treatment methods of the ankle and foot

The treatment of diseases and injuries of the ankle or foot in the first stage is based on conservative treatment, i.e., the use of anti-inflammatory and analgesic drugs and rehabilitation. In the event that conservative treatment does not bring the expected results, a decision is made to operate.
At the Carolina Medical Center, we provide a full range of ankle and foot surgeries. We carry outminimally invasive ankle arthroscopy. In a situation where degenerative changes are advanced and the ankle joint is completely destroyed, two treatment options are possible: alloplasty, ci.e., implantation of an endoprosthesis, or rthrodesis, i.e., ankle joint stiffening.

We also perform bunion surgery in our clinic.

Rehabilitation of the ankle and foot

Rehabilitation of the ankle and foot is a very important element of treatment immediately after an injury. 

In the initial stage, rehabilitation is aimed at minimizing pain, reducing swelling and restoring full mobility of the joint. A key element of ankle or foot rehabilitation is also the reconstruction of muscle mass, the decrease of which can be observed during the immobilization of the joint (e.g., after a fracture).

Damaged ligaments and the joint capsule are the carriers of the deep sensory receptors. In cases of trauma, they also get damaged, as do the mechanisms supporting the maintenance of balance. Therefore, after completing the rehabilitation process, the physiotherapist may recommend training that includes stabilizing exercises.

It should be remembered that poorly healed ligaments and a too quick return to activity after ankle or foot injuries will predispose to further injuries. Therefore, rehabilitation is crucial to fully return to fitness and activity.

lek. Urszula Zdanowicz

Specjalista ortopedii i traumatologii narządu ruchu, Kierownik Działu Nauki

Specjalizuję się w zabiegach artroskopowych i rekonstrukcyjnych stawu kolanowego i skokowego oraz w rekonstrukcjach tkanek miękkich, m.in. ścięgna Achillesa. Jestem Kierownikiem Naukowym Carolina Medical Center oraz Członkiem Faculty McGowan Institute for Regenerative Medicine Uniwersytetu w Pittsburgu. Przyjmuję dzieci od 3 r.ż.

Treatment methods: Ankle and foot

  1. Ankle arthrodesis
  2. Ankle arthroscopy
  3. Ankle arthroscopy and ligament reinsertion
  4. Ankle arthroscopy and ligament fixation (open treatment)
  5. Ankle arthroscopy and/or medial ankle arthroscopy and osteotomy with screw fixation. Cavity filling.
  6. Ankle arthroplasty
  7. Achilles deep bursa endoscopy – Haglund
  8. Hyprocure system implantation into the tarsal sinus – unilateral / bilateral
  9. Hammer toe correction
  10. Correction of bunion
  11. Correction of bunion and hammer toe – unilateral / bilateral
  12. Osteotomy in the area of the foot and ankle
  13. Ingrown nail
  14. Plastic surgery of hallux rigidus – arthroscopic / open treatment
  15. Plantar aponeurosis surgery
  16. Percutaneous suturing of the Achilles tendon
  17. Hindfoot reconstruction (tendon transfer, spring ligament reconstruction, subtalar arthrodesis / calcaneus osteotomy)
  18. Reposition and stabilization of a toe fracture with “K” wire
  19. Revision of partial damage to the Achilles tendon
  20. Separation of syndactyly
  21. Open ankle stabilization (no arthroscopy)
  22. Stabilization of the fibular tendons
  23. TightRope stabilization of tibiofibular ligament
  24. Primary tendon suture
  25. Transfer of the posterior tibial tendon to the back of the foot
  26. Tendon release – tenolysis
  27. Secondary tendon stitching
  28. Fracture fixation of the metatarsal bones
  29. Stitching complete damage to the Achilles tendon
  30. Stitching of the medial head of the gastrocnemius muscle
  31. Fracture of the distal end of the tibia – complicated, trans-articular – procedure with possible use of an arthroscope.
  32. Fracture of the lateral ankle (with possible damage to the syndesmosis) – procedure with the possible use of an arthroscope.
  33. Fracture of the lateral and medial ankle with damage to the syndesmosis – procedure with the possible use of an arthroscope.
  34. Trimalleolar fracture – procedure with the possible use of an arthroscope.
  35. Fracture within the tarsal bone

Injuries and ailments: foot and ankle joint

  • Hallux Valgus (Bunion)
  • Fracture of the 5th metatarsal bone
  • Haglund’s deformity
  • Meniscoid
  • Sesamoiditis
  • Pathology of the tendons of the fibular muscles
  • Ankle dislocation
  • Fractures in the ankle
  • Ankle sprains
  • Arthrosis of the ankle

[1] Röding F, Lindkvist M, Bergström U, Lysholm J. Epidemiologic patterns of injuries treated at the emergency department of a Swedish medical center. Inj Epidemiol 2015;2:3.
[2] Nabian M, Zadegan S, Zanjani L, Mehrpour S. Epidemiology of joint dislocations and ligamentous/tendinous injuries among 2,700 patients: five-year trend of a tertiary center in Iran. Arch Bone Jt Surg 2017;5:426–34.
[3] Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier T, Wikstrom E. The epidemiology of lateral ligament complex ankle sprains in national collegiate athletic association sports. Am J Sports Med 2017;45:201–9; Hootman JM, Dick R, Agel J. Epidemiology of coiiegiate injuries for 15 sports. J Athl Train 2007;2:311–9.
[4] Barg A, Pagenstert GI, Hügle T, Gloyer M, Wiewiorksi M, Henninger H, et al. Ankle osteoarthritis: etiology, diagnostics, and classification. Foot Ankle Clin 2013;18:412–26.
Saltzman Charles L, Salamon Michael L, Michael Blanchard G, Huff Thomas, Hayes Andrea, Buckwalter Joseph A, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. 2004. . [Accessed 20 July 2017] https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1888779/pdf/IowaOrthopJ-25-044.pdf.
Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res 2009;467(7)1800–6, doi:http://dx. doi.org/10.1007/s11999-008-0543-6 Epub 2008 Oct 2.
[5] Cushnaghan J, Dieppe P. Study of 500 patients with limb joint osteoarthritis. I. Analysis by age, sex, and distribution of symptomatic joint sites. Ann Rheum Dis 1991;50:8–13.
Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res 2009;467(7)1800–6, doi:http://dx. doi.org/10.1007/s11999-008-0543-6 Epub 2008 Oct 2.
Barg A, Pagenstert GI, Hügle T, Gloyer M, Wiewiorksi M, Henninger H, et al. Ankle osteoarthritis: etiology, diagnostics, and classification. Foot Ankle Clin 2013;18:412–26.

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