Arthroscopy, sometimes known as “keyhole surgery,” is a type of endoscopy—a surgical technique used to look inside the body without cutting it open. Performing arthroscopic surgery on the foot or ankle requires the use of a very small fiber-optic camera called an arthroscope.
This device is inserted into the ankle joint, and it transmits magnified images of the inner workings of the joint and displays them on a video monitor, allowing the surgeon to perform complex operations in a minimally invasive way, without the need for large incisions.
Why is Arthroscopic Surgery Performed on the Foot and Ankle?
Arthroscopy enables a surgeon to perform operations without the need for large incisions that can traumatize the patient and take a long time to heal properly.
Arthroscopic ankle fusion, for example, is often a viable alternative to open ankle fusion. This procedure minimizes the post-operative pain that would accompany a more drastic “open” procedure, and it tends to shorten recovery time following surgery. The risk of infection is also lower than with open surgery.
Foot and ankle arthroscopy is also frequently used as a diagnostic tool.
If x-rays, CT scans, and other imaging tools fail to provide a doctor with the information he or she needs in order to be able to diagnose a problem with a patient’s foot or ankle, arthroscopy can enable the doctor to look more closely at the inner workings of the joint in order to determine the nature of the patient’s problem and what needs to be done about it.
Arthroscopic surgery can be used to treat or diagnose a wide variety of foot and ankle conditions, including:
- Ankle fractures
- Torn ligaments
- Removal of loose bone or cartilage
- Pain in the subtalar joint (the joint just below the ankle that allows for side-to-side movement), such as may be caused by a severe sprain or twisting injury, is often addressed by arthroscopic ankle surgery.
- Synovitis, an inflammation of the tissue lining the ankle joint, can sometimes be treated by using ankle arthroscopy to remove the inflamed tissue. However, this inflammation is sometimes caused by infections in the synovial tissue, in which case arthroscopic surgery is contraindicated.
- Ankle arthritis can often be treated with arthroscopic ankle fusion surgery
- Ankle instability caused by stretched ligaments can sometimes be corrected by employing arthroscopic surgery
- When scar tissue forms within the ankle joint, it can cause a painful condition known as arthrofibrosis. Arthroscopic surgery can be used to locate and remove the scar tissue.
When arthroscopic surgery was first developed in the early 1960s (by a Japanese doctor named Masaki Watanabe), its only purpose was to diagnose conditions that would later need to be treated with open surgery.
However, minimally invasive modern surgical techniques have made it possible for many foot and ankle conditions to be corrected arthroscopically.
What is an Arthroscope?
An arthroscope looks like a long, thin, flexible tube, roughly the diameter of a pencil or a drinking straw.
It contains a video camera and a bright light, and tiny, specially designed surgical instruments can sometimes be attached to it and operated remotely through the arthroscope. The word arthroscopy is derived from arthro (the Greek word for joint) and skopein (Greek for “to look”).
What to Expect When Having Foot and Ankle Arthroscopy
Before your arthroscopic procedure begins, you will be given an anesthetic—either general or local anesthesia or an epidural (drugs injected directly into the spine).
Once the anesthesia has taken effect, the ankle joint is distended with the injection of saline solution in order to allow the surgeon more visibility and more space in which to operate. Then a small, buttonhole-sized incision will be made, through which the arthroscope will be inserted.
Other small incisions may be made nearby in order to provide the surgeon with a better view of other parts of the joint, or to insert other surgical instruments.
If your particular foot or ankle arthroscopy is corrective in nature, rather than exploratory, the surgeon will perform the operation through these incisions, using the arthroscope to see what he is doing.
After your surgery, the incisions will be bandaged and you will be moved to a room where you can recover.
How long recovery takes will depend on the type of surgery you have, and what condition has been addressed by it, but it is not uncommon for patients to resume some of their normal activities within a few days, and many patients do not even require pain medication during their recovery period.
It is not even unheard of for professional athletes to resume playing within a matter of weeks, although as noted above, this depends entirely on what kind of arthroscopic surgery was performed.
Foot and Ankle Arthroscopy Risks and Complications
Apart from the risks associated with any type of surgery (infection, bleeding, reactions to anesthesia, etc.), the most common complication resulting from arthroscopic surgery is injury to the nerves or blood vessels in the ankle joint.
Fortunately, fewer than one percent of patients experience such complications. About 10 percent of patients will experience some numbness or tingling on the top of whichever foot was operated on. This discomfort typically goes away on its own in time.