‘Arthro’ means joint and ‘scopy’ means visual examination. It was first performed in the foot and ankle in Tokyo, Japan, in 1939, however the procedure did not become much more widespread and commonly used until the 1980’s.
Arthroscopy allows direct visualisation of all joint structures without an extensive surgical approach, with correspondingly decreased pain, accelerated recovery times and reduced complication rates compared with open procedures. The joint can be inspected in real-time and actual function determined to accurately delineate pathology. It is utilised to address problems such as removal of scar and inflammed tissue, loose bodies, impinging bone spurs, repair structures, arthrodese/fuse joints for arthritis, remove inflamed tissue around tendons and impingement on tendons, provide diagnosis where x-rays and other scans cannot, take biopsies of tissue, and remove infections from the joint.
A disadvantage of foot and ankle arthroscopy is that it requires very specialised techniques, with extensive training, and steep associated learning curves. You can be rest assured however, that our Foot and Ankle Specialist Dr James Clayton has spent extensive time training with experts around the world and have had considerable experience, with thousands of procedures performed over the years.
A very light general anaesthetic is all that is required. A tube at the back of the throat to protect the airway is used rather than formal intubation; which essentially removes the risk of damage to the vocal cords. A local anaesthetic block at the knee, or foot for the big toe, is placed at the start of the procedure. This reduces the need for heavier general anaesthetics, and accordingly you should not wake up not feeling sick, and be clear of head and mind. The blocks on average last 24 hours, and so you should not have any pain at all during this period. It then allows time to start your tablet pain killers as the block is wearing off and prevents the requirement for injection pain killers.
Generally, two incisions also known as portals, are made. The first portal is to allow passage of the camera into the region to be examined. The camera is 2.9mm in diameter and is connected by a fibre-optic cable to a high definition LCD screen. This allows the examination and management of various conditions in the ankle, subtalar, and big toe joints as well as several soft tissue structures including tendons and the plantar fascia on the bottom of the foot. To be specific though, examination of the tendons is called tendoscopy and of the plantar fascia, endoscopy. The other portal is utilised for instrument access. Instruments include suction shavers, burrs, osteotomes (chisels), probes, curettes, diathermy (to cauterise bleeding), and grasping instruments.
Ankle distractors that provide traction attached to the bed have been utilised in the past however are not required in modern day surgery. They can cause damage by traction injuries to soft tissues such as nerves, tendon, ligaments and muscles and are contraindicated altogether in children with open growth plates. While they may improve visualisation of the central joint, they restrict visualisation of all other aspects of the joint where at least 95% of causes of pain exist. They also do not allow visualisation in real time with joint movement to determine the exact cause of your problem, as joints by definition are not static but dynamic structures.
If procedures in addition to the arthroscopy are not required, usually just a stick-on dressing is used and normal shoes can be worn, and full weight bearing allowed, from the day after surgery. Finally, every patient is provided with detailed photographs and descriptions of their procedure to take home and show their physiotherapists and podiatrists. It contains information on post-operative care of dressings and required rehabilitation to assist in obtaining a successful outcome. A copy of this report will also be sent directly to your general practitioner.
RISKS AND COMPLICATIONS
Complications are rare with these procedures. Aside from the usual risks of surgery, such as infection & blood clots, a temporary hypersensitivity of the foot may occur and delay recovery. An active rehabilitation program with an experienced physiotherapist or podiatrist is important in minimising risks. Temporary nerve irritation from portal scarring occurs rarely and almost exclusively resolves with time. Stiffness usually resolves with physiotherapy and time. Occasionally a cortisone injection is required to settle a sensitive and reactive joint down. Rarely is further surgery required to manipulate or re-arthroscope the joint to break down and or remove scar tissue
|Hospital stay||Day surgery|
|Rest and elevation||1 week|
|Time off work |
|Foot swelling||3-4 weeks|
This fact sheet is a brief overview of foot and ankle arthroscopy, produced by our Foot and Ankle Surgeon Dr James Clayton. To make an appointment or enquiry with Dr Clayton, contact 08 8362 7788 or email firstname.lastname@example.org.