Total Ankle Replacements

By Dr. Patrick Briggs, Podiatrist

1. Why would you need a Total Ankle Replacement?

Arthritis is the most common reason for a patient to need a total ankle replacement. Patients have pain and/or arthritis due to circumstances such as bad sprains, previous trauma, ankle fractures, rheumatoid arthritis and/or osteoarthritis. Others have post traumatic pain from athletics or previous accident where damage was done to the cartilage. We go through a series of conservative treatment options before a total ankle replacement may be warranted.

2. What are the signs and symptoms of someone who would need a total ankle replacement?

The patient may be progressively getting worse with more pain, often limping with swelling and aching that slows them down but doesn’t necessarily prevent them from their normal activities of daily living. It tends to be a progressive disease where symptoms may warrant a total ankle replacement. Patient may complain about swelling and pain within the ankle joint that tends to increase with increased activity.

3. How would the patient be diagnosed?

The clinical exam would elicit pinpoint tenderness over patient’s ankle joint, range of motion of the ankle would often be guarded and x-rays would confirm degree of treatment.

4. What would the treatment options be before surgery?

Surgery is the last option after we have worked together on decreasing pain and using less invasive options of treatment. We would start with anti-inflammatory medications, possible bracing, orthotics, injections into the arthritic site, physical therapy and strengthening. Plan would be directed to improve functionality of the ankle and to decrease pain.

5. Total Ankle Reconstruction information and outcomes.

In 2009, the total ankle replacement became FDA approved. There are three components to STAR Implant – the top piece goes into the tibia, the bottom piece goes into the talus and in the middle, is the polyethylene (white plastic) which allows the patient mobility in the joint. The STAR implant will allow the patient to point their foot up and down, left and right and rotate into full circles. The surgical procedure lasts about an hour and a half. The life span of the implant is 10 to 15 years long. There are a few other implants approved in the U.S. each with its certain advantages. They type of ankle replacement used is often determined by the surgeon’s preference.

6. What is the recovery on the Total Ankle Replacement surgery?

The patient will have two weeks of non-weight bearing, primarily to allow the incision to heal properly. After the two weeks, they will wear a protective weight bearing boot and then by week five they can wear their own tennis shoe.

All About Bunions

What is a Bunion?

podiatry-docsA bunion, hallux valgus, is a misalignment of the first metatarsal bone where the big toe leans toward the second toe causing a large bump on the inside of the foot.  A bunion is a progressive deformity, as it gets worse over time and causes more pain as the bunion grows.  Bunions do not go away.

Causes:  Contrary to popular belief, shoes or high heels do not cause bunions. Bunions can be caused by hereditary factors (thank your parents) and certain foot structures that are prone to developing a bunion.

Symptoms and Diagnosis:  Bunions cause pain, redness or inflammation, burning and even numbness over the bunion site and may affect other toes.  The severity of the bunion is determined with an x-ray in your Podiatrist’s office.

Treatment:  Treatment for bunions includes non-surgical and surgical options. Non-surgical options include choosing a wider or squared off shoe, padding over the bunion site, modification of activity, anti-inflammatory medication, icing, possible cortisone injections and/or custom orthotics.

Surgical treatment aims at correcting and realigning the first metatarsal bone to alleviate pain and improve activity levels.  The Foot and Ankle surgeon will determine the type of surgical correction needed based on clinical and x-ray evaluation. The chosen surgical procedure affects the length of recovery time after surgery.

What is a Tailor’s Bunion?

A Tailor’s bunion is also called a bunionette.  It’s essentially a prominence or bowing of the fifth metatarsal on the outside of the foot.  The name arose from centuries prior, when tailors sat cross-legged causing the outside of their foot rubbed on the ground.

Causes:  Like a bunion, tailor’s bunions are inherited resulting from a certain foot structure.  Shoes or trauma are rarely the cause.  However, shoes may aggravate one’s symptoms if the shoe is too narrow in the toes.

Symptoms and Diagnosis:  Most will complain of redness, swelling or pain directly over the prominence or bump on the outside of the foot.  The diagnosis of a tailor’s bunion can be easily diagnosed with a physical exam and x-rays in your Podiatrists office.

Treatment:  Often tailor’s bunions can be treated conservatively with shoe modifications, padding, oral medications (non-steroidal), and icing.  However, depending on the symptoms and success of conservative care, surgery may be necessary.   A Foot and Ankle Surgeon would help you decide when surgery is indicated and the type of procedure is most appropriate.

Dr. Markus Giacomuzzi (left) and Dr. Patrick Briggs (right) are both board-certified by the American Board of Podiatric Surgery and are Fellows of the American College of Foot and Ankle Surgeons. Both physicians specialize in the treatment of bunions, heel pain/plantar fasciitis, ingrown toenails, hammertoes, pediatric foot deformities, dermatological conditions of the foot, foot and ankle reconstruction, sports medicine, tendon injuries, sprains and fractures, custom orthotics and bracing, diabetic exams, vascular evaluation, neuromas, and wound care and limb salvation.

Dr. Giacommuzi and Dr. Briggs are physicians in the Podiatry department at Texas Gulf Coast Medical Systems (TGC) and on staff with Bay Area Regional Medical Center, the area’s newest and most modern hospital and TGC affiliate. Texas Gulf Coast provides ongoing, comprehensive care with specialties in Family Medicine, Internal Medicine, Pediatrics, Neurology, Endocrinology, Podiatry, Dermatology and Mental Health. Texas Gulf Coast is open Monday through Friday and offers convenient same-day, walk-in sick visits, extended hours and multiple locations.

To learn more or to schedule an appointment call 281.724.0368.






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