December 2012

   Todd Haddon, DPM, typically sees patients with ankle arthritis two to three times per week in his practice. Many of these cases are post-traumatic, requiring “fairly aggressive conservative treatment” explains Dr. Haddon, a Fellow of the American College of Foot and Ankle Surgeons.

   “Initial surgical options in our practice typically include an ankle-joint arthroscopy with debridement and microfracture with occasional use of particulate juvenile articular cartilage grafting,” adds Dr. Haddon.

   In regard to certain risk factors affecting procedural results, Dr. Haddon agrees with the study authors that body mass index (BMI) and large intra-articular lesions correlate with poor outcomes.

   “There have been several patients I have treated with arthritis that have made significant improvements in pain with weight loss alone prior to any surgery,” Dr. Haddon adds. “In addition, patients that smoke seem to not do as well, particularly when any bone grafting is taking place.”

   Similarly, Jesse Burks, DPM, sees ankle osteoarthritis very often in his practice, noting arthroscopy is beneficial with patients who have failed more conservative measures but may not require a larger procedure such as arthrodesis or replacement.

   “I always counsel patients that the arthrosis typically progresses and a more definitive procedure may very well be needed,” explains Dr. Burks, a Fellow of the American College of Foot and Ankle Surgeons who practices in Little Rock, Ark.

   Dr. Haddon also reminds patients to be realistic with their expectations following this type of surgery, noting as of yet, arthroscopy is just one treatment and not a cure.

   “As the article suggests, complete, 100 percent (recovery) is not often realistic and even significant gains may not be permanent,” adds Dr. Haddon. “Make sure patients are aware that arthritis is progressive and will often come back, causing difficulties again in the future.”

Is A Uniportal EGR System Effective For Gastrocnemius Equinus?

By Brian McCurdy, Senior Editor

A recent study in the Journal of Foot and Ankle Surgery notes that a one-portal endoscopic gastrocnemius equinus recession (EGR) system has potential in treating equinus, with advantages over a two-portal system.

   The study focused on 53 patients who received 60 uniportal EGRs. Patients’ mean preoperative range of ankle dorsiflexion was -2.9 degrees (± 1.9 degrees) while their post-op dorsiflexion was 12.8 degrees (± 1.7 degrees), an increase of 15.7 degrees, notes the study. The authors note four complications but no incidences of wound dehiscence or delayed healing, painful scar formation or infection.

   When compared to open procedures and other endoscopic techniques, study author Stephen Schroeder, DPM, cites numerous advantages to the uniportal EGR system. He notes one can easily perform this with the patient in the supine position, saving time, whereas open procedures need to occur with the patient prone or in an awkward frog-leg position.

   Dr. Schroeder also says the uniportal procedure lasts about four minutes from skin incision to closure and has far superior cosmesis when compared to an open procedure, which he notes is very important to a lot of patients. He adds that the lessened scar tissue theoretically should lead to an easier rehab.

   Furthermore, the uniportal approach is less likely to create neurovascular complications in comparison to a two-portal approach, notes Dr. Schroeder, the Chief of Podiatric Surgery at Peace Health Southwest Washington Medical Center in Vancouver, Wash. His EGR system provides better visualization and comes with a retractable blade, which he says is more accurate and leads to fewer complications. He notes the system in his study also protects the neurovascular structures and provides clear visualization of the aponeurosis before transection.

   The uniportal EGR does have a learning curve and Dr. Schroeder notes that improper portal placement and poor visualization can be potential problems with some systems.

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