By Alexander Germanis
During the spring planting season, it is not uncommon to see young saplings planted down boulevards or in someone’s front yard that are anchored with guy wires or ropes to stabilize them and keep them upright during their formative years of growth. Without these supports, the trees could easily grow out of plumb, or out of true vertical alignment.
We instinctively seek to remain as close to true vertical in our lives as well. However, as we are not burying roots underground and few probably want to be tied to stakes in the dirt, our bodies have an in-built system to help us stay plumb. The ankle joints are, in a sense, the body’s guy wires.
Although also playing vital roles in balance and locomotion, due to their size, placement, and rather complex structure, there are numerous ways in which the ankle may cease to function properly, succumb to injury, or even require replacement.
“An ankle replacement is potentially the result of multiple predisposing factors,” states Dr. Tuvi Mendel of Orthopaedic Specialists in the Quad Cities. “Posttraumatic degenerative changes with residual deformity and mal unions; previous injuries or broken bones around the foot and ankle; severe chronic flatfoot deformity; gait issues, possibly related to knee and/or hip and low back pathology; large volume of impact activities; being overweight; or an inflammatory-type condition such as rheumatoid arthritis.”
For these reasons, surgery of the joint requires additional orthopaedic subspeciality training and, just as important, experience. Currently, Dr. Mendel is the only surgeon in the Quad Cities with such qualifications.
Nevertheless, he still sees each surgery as a challenge, which is what lured him to orthopaedics in the first place. With ankles, part of that challenge is staying current with all the latest techniques.
“At this point, I’m utilizing a CT scan to obtain a 3D reconstruction of the deformity of the ankle,” the doctor explains. “I generate 3D, patient-specific guides, which I utilize at the time of surgery to help perform precise bone cuts and component positioning for the best outcome. This is done as an outpatient procedure.”
Trained on all versions of total ankle arthroplasty, Dr. Mendel looks forward to a time in the near future when robotic assistance will become integrated in ankle replacement surgery, aiding in component implantation.
Even with these surgical steps forward taken into account, recovery is still, understandably, a long and delicate period. The ankle must not bear any weight for six weeks following surgery, with another six weeks often necessary to return to reasonable daily function. Physical therapy begins two weeks post-op, with stitches being removed around the same time. “After the six weeks of non-weight bearing, patients continue to wear the brace for an additional four weeks with weight bearing as tolerated and physical therapy,” Dr. Mendel outlines. “And then they advance into regular shoes with gradual progression to normal activities.”
Of course, not everyone needs or should even undergo replacement surgery. “Nonsurgical management includes physical therapy, shoe modification with inserts, bracing, injections, and anti-inflammatories,” says Dr. Mendel. “Contraindications for total ankle include significant peripheral vascular disease or peripheral neuropathy, significant obesity, severe deformity, and bone deficit.”
Should ankle replacement be the path to take, however, Dr. Mendel advises abstaining from certain activities such as high-impact exercises like running and jumping. Low-impact exercises like swimming, cycling, elliptical, or rowing can help extend the viability of the replacement, with the average longevity of the prosthesis sitting at about 15 years.
Regardless of the methods forward, should your world be off-kilter due to an ankle issue, there are multiple options and improvements in orthopaedics to help return you to standing true.
Orthopaedic Specialists have locations at 3385 Dexter Court, Suite 300, in Davenport, Iowa, and at 2635 Lincoln Way, #D, in Clinton, Iowa. If you would like to request an appointment, please call us at (563) 344-9292. And visit us on the web at www.osquadcities.com.