Ankle arthroscopy is a one-day surgery procedure. Its purpose is to diagnose and treat damaged structures of the joint. The whole thing is to insert the arthroscope and small tools into the joint, which are manipulated while viewing the image of the joint on the monitor screen.

The procedure is usually performed under spinal anesthesia, which means that the patient is conscious all the time and has one or both lower limbs temporarily incapacitated.

The length of the procedure depends on the type of arthroscopy performed and the degree of damage to the ankle joint as well as the treatment method used. Usually, the entire procedure takes no more than 60 minutes.

Arthrodesis is a surgical procedure to stiffen the ankle joint. For this purpose, the articular surfaces are removed and the tibia is joined with the talus bone so that they become permanent fusing. Movement in the place of the operated joint is impossible, which is the intended effect - thanks to the stiffening of the ankle joint, pain relief, correction of incorrect positioning and restoration of the limb support function are achieved.

The arthrodesis procedure is most often performed in patients who suffer from pain associated with advanced degenerative changes of the ankle joint. The condition for qualification is the lack of effects of conservative treatment or the lack of purposefulness of undertaking other methods of surgical treatment. Stiffening of the ankle joint is also performed in extensive post-traumatic conditions involving the ankle joint. In addition, arthrodesis can be used as a method of correcting foot deformities, such as fixed flatfoot or clubfoot in adults.

Most patients are given epidural anesthesia to eliminate feeling from the waist down or the nerves supplying the operated limb are blocked. The ankle brace procedure is most often performed by the open method - the surgeon makes an incision of several centimeters on the side or in front of the ankle joint. Thanks to this, it has maximum access to the pond and can precisely correct its incorrect position. Arthrodesis can also be performed using the arthroscopic method, which leaves minimal scars (up to 4mm), but this method is reserved for smaller degrees of deformation.

During the operation, the surgeon removes the debris of the damaged cartilage, and then prepares the end of the tibia and the talus to allow them to heal later in the corrected position. The connection is stabilized with special screws or plates. The wounds are closed and a plaster splint is placed over the foot and ankle.

To prevent the development of bunions, it is recommended to regularly strengthen the foot muscles, stretch the calves, wear comfortable footwear with wide toe boxes, maintain a healthy body weight, and avoid prolonged periods of standing. It's important to keep in mind that factors such as genetic conditions, rheumatoid arthritis, and diabetes can contribute to the development of hallux valgus, so it's not always possible to completely prevent bunions. However, we can take steps to slow down the progression of the deformity. People who are more susceptible to bunions should undergo regular foot examinations to detect the condition in its early stages.

Bunion surgery is the only effective way to permanently correct deformation. It makes it possible to reduce the width of the foot and straighten the big toe, thanks to which the desired cosmetic effect and reduction of pain are obtained after the treatment. Conservative treatment, i.e. wearing haluksy braces or orthopedic insoles, may alleviate symptoms, but does not reduce deformities.

Orthopaedists advise undergoing a surgical procedure for hallux valgus when it becomes difficult to wear normal shoes comfortably due to the size of the painful bunion, and when the pain is severe enough to significantly affect the quality of life. The physician should have a comprehensive conversation with the patient regarding the expected outcomes of the surgery, taking into account the patient's expectations.

The length of convalescence after the bunion treatment depends on the initial degree of deformation and the extent of the treatment. Full recovery in most cases is possible in the third month after the procedure. An important role is played by the patient's involvement in rehabilitation, which significantly speeds up the recovery process after surgery.

After your surgery, you will need to wear a specialized orthosis called a Barouk shoe to help relieve pressure on your operated forefoot. It will take approximately 6 weeks for the bones to fuse properly before you can begin walking in normal shoes again. 

A well-planned and carefully performed bunion surgery brings lasting results. If the patient follows the specific recommendations of the orthopedist and physical therapist, there is no possibility of the hallux recurrence. Wearing high-heeled shoes or shoes with narrow toes is contraindicated as, regardless of the result of the operation, it may cause the big toe to curvature again.

The indications for surgical treatment of ankle instability include:

complete rupture of ligaments with acute instability of the ankle joint, which seriously disrupts biomechanics and prevents the patient from returning to normal activity,
another habitual ankle sprain, which could not be brought about by conservative treatment to a state in which the patient could function freely without pain symptoms,
chronic mechanical instability, when conservative treatment does not bring the results expected by the patient, e.g. alleviating pain,

The Internal Bracing method is based on the use of strong sutures or a non-absorbable polystyrene tape, which additionally strengthens the repair performed on the patient's own tissues - in the case of the ankle joint of the articular bag with a ligament. The advantage of the Internal Bracing method is the preservation of your own ligament without the need to collect the graft and faster return to normal activity after the procedure due to the high primary strength of the implants.

Untreated chronic ankle instability increases the risk of habitual ankle sprains, subsequent cartilage and / or sagittal injuries, and leads to the acceleration of degenerative changes manifested by gradual limitation of the range of motion and ankle pain that makes walking difficult.

In children up to 7 years of age, there is physiological flat feet, which means that children's flat valgus foot is a natural stage in the development of the lower limbs. In order to stimulate the outgrowth of physiological valgus, give the child plenty of exercise, and especially allow the child to walk barefoot on a variety of surfaces - this stimulates the foot muscles to work. Flat feet should always be monitored, especially in cases where there are aggravating factors: excessive joint laxity, overweight, muscle tone disorders or abnormalities in the hips. The final decision as to treatment is made by the orthopedic surgeon after thorough diagnostics. Conservative treatment includes exercises to strengthen the feet, exercises to stimulate the correct positioning of the lower limb and the possible wearing of orthopedic insoles. The indication for surgery is painful flat feet, rapidly progressing and not amenable to conservative treatment.

The type of treatment depends on whether the flat feet are still flexible (can be actively corrected) or the defect has already been fixed. If we are dealing with flexible flatfoot, one of the methods used is to place a small implant in the tarsal sinus. The tarsal sinus is the space between the ankle bone and the calcaneus, felt through the skin as a depression in the foot in front of the lateral ankle. The procedure is a minimally invasive one, therefore the return to walking is much faster compared to classic correction methods. The implant placement procedure can be performed in children over 3 years of age and in adults with corrective flat feet. Fixed flat feet with degenerative changes in the foot and ankle are operated using other methods, the choice of which is up to the surgeon.

Relief in ailments caused by transverse flat feet is provided by the use of individually made orthopedic insoles. The inserts on the transverse platform relieve the forefoot and normalize the pressure distribution under the feet, thanks to which the foot is less painful. The insoles work when worn in shoes. Permanent improvement in ailments and correction of accompanying deformities of the fingers can be achieved through surgery. The surgical procedure allows you to straighten the bunion, hammer or claw toes and change the shape of the foot to improve comfort while walking.

The length of convalescence depends on the extent of the procedure and the surgical technique used. For the first 6 weeks, the patient should wear a special shoe that relieves the operated part of the foot. Return to full activity is usually possible in the third month after the procedure, but it may be shortened if the procedure was performed using a minimally invasive technique.

In the case of Achilles tendon pain, an orthopedist should be consulted, who will accurately diagnose the cause of the ailments and establish a treatment plan. The management consists mainly of a temporary limitation of sports activity, performing eccentric calf muscle exercises and procedures in the field of physical therapy. In the treatment of chronic Achilles tendinopathy, modern methods are used to stimulate the processes of proper healing and tissue repair, e.g. the Topaz electrode coblation procedure.

Strengthening the Achilles tendon by stimulating the reconstruction of the fiber structure can be achieved by performing eccentric training according to the Alfredson protocol. This training involves the controlled lowering of the heel down below the level of the step on which the forefoot rests. The exercise is performed with the knee extended and then bent. The training includes 15 repetitions in 3 series in the morning and evening for a minimum period of 3-6 months. To be sure that the exercise is being performed correctly, it's best to check with your physical therapist.

The rigid big toe is manifested by pain in the metatarsophalangeal joint of the big toe while walking, when the heel rises above the ground and the foot prepares to take off. Pain often makes it impossible to fully climb on toes or wear high-heeled shoes. The bone conflict results from the presence of degenerative changes that limit the passive dorsiflexion of the big toe. X-ray images show a narrowing of the joint space and the presence of bone spurs (osteophytes).

The metatarsophalangeal arthrodesis of the big toe is an effective form of surgical treatment of the rigid big toe. The procedure consists in cutting out the articular surfaces and then permanent stiffening of the big toe joint in a slight dorsiflexion. The treatment relieves pain and allows the patient to freely take up everyday activities, and even play sports.

After the procedure, the patient should move in a special shoe that relieves the front of the foot. This is necessary for a period of about 6 weeks or until the toe joint is firmly in place.

The cheilectomy procedure, i.e. the removal of degenerative changes inhibiting the dorsiflexion of the big toe, is performed in young active people who complain of pain in the big toe joint with the accompanying limited mobility. The condition for the success of the operation is the initial stage of degenerative changes in the big toe joint - the head of the metatarsal bone should have more than half of the undamaged articular cartilage. Only then is it possible to restore the painless range of motion of the big toe.

During subluxation of the tendons of the peroneal muscles, they abnormally shift forward to the lateral ankle. It is accompanied by damage to the upper cord of the fibula muscles, which should keep the tendons in their correct position. Symptoms of subluxation are pain and a feeling of jumping the tendon on the side of the ankle joint, which is most easily observed when placing your foot on the outer edge of the foot or when trying to deform the ankle joint.

The risk of subluxation or dislocation of the fibula tendons is increased in people who have an anatomically too shallow groove of the fibula in which the tendons of these muscles lie. Additional varus position of the heel predisposes to overloading the strap and weakening its structure. A history of inversion ankle sprain and chronic lateral instability of the ankle joint are also a risk factor for this type of injury.

Sagittal muscle dislocations are most often treated surgically. The procedure involves the repair or reconstruction of the upper reticulum of the fibula muscles, which holds the tendons behind the lateral ankle. Additionally, it is possible to deepen the too shallow groove of the fibula or build up the posterior edge of the fibula with bone blocks to better stabilize the tendons in their anatomical position. After surgery, you should participate in regular rehabilitation, the main goal of which will be to restore the muscular stabilization of the ankle joint and safely return to normal activity.

The accessory triangular bone is found in 7-25% of people and is located at the back of the talus. In most cases, its presence does not cause any discomfort. In athletes who perform repeated plantar flexion movements (such as ballerinas who climb toes), the triangular ankle may be irritated as manifested by overload pain at the back of the ankle.

An additional navicular bone lies on the medial side of the tarsus. The pain is exacerbated by the conflict between the protruding ankle and the upper of the shoes. In the case of a flat valgus foot, the discomforts can be alleviated by using an insole correcting the incorrect position of the foot. Failure to achieve the desired effect may be an indication for the surgical removal of the additional navicular bone.

Surgical excision of the accessory ankle is performed in the event of an acute injury that resulted in a fracture of the accessory ankle. Surgical treatment also includes conditions where medical treatment has not been successful.

There are many ways to treat hammer fingers, such as finger exercises, manual therapy by a physical therapist, and wearing special finger straightening orthoses. There are strategies that allow you to relieve ailments, slow down the progression of deformity or improve the position of the fingers for a short time. In order to obtain the desired shape of the fingers permanently, it is recommended to undergo surgery.

An indication for surgery is any degree of deformation of the hammer toes, which causes pain and makes it difficult to use everyday shoes.

Thanks to the stiffening of the finger with wire, very good results are obtained, but in some cases internal implants are also used. The decision on the type of anastomosis is made by the surgeon - depending on the type of deformity and the patient's expectations. Internal implants cost a treatment several hundred zlotys and provide worse stability than the classic so-called Kirschner rod.

A broken ankle should not be weighed down for at least 6-8 weeks, and in some cases even for 10 weeks. During this period, the patient uses crutches, initially wearing a plaster shoe and then wearing a special Walker brace. Gradual load on the limbs can only be started after receiving information from the orthopaedist regarding the occurrence of bone union.

The rehabilitation time after an ankle fracture varies - depending on the severity of the injury, it may last from 3 to 8 months. The patient's involvement in the rehabilitation process is of great importance for the duration of the recovery. Rehabilitation should always be carried out in cooperation with the physiotherapist and the orthopedist who performs the surgery or conducts conservative treatment.

Minor pain in the first 2-3 months after an ankle fracture may result from active bone remodeling processes. The active participation of the patient in rehabilitation allows to prevent pains resulting from the presence of postoperative scars or tissue adaptation to re-burdening with body weight. It should be borne in mind that some complex types of fractures may prevent the perfect reconstruction of the articular surfaces, which is related to a certain limitation of the ankle joint function. Some patients with massive ankle injuries may develop degenerative changes within 2-10 years despite maximum care.

Achilles tendon suturing should be performed as soon as possible - no later than 6 weeks after the injury. The longer the procedure is delayed, the greater the risk of shortening and atrophy of the calf triceps muscle. An early procedure allows the Achilles tendon to be fully restored using classical methods, without the need to extend the tendon or harvest grafts.