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Foot and ankle surgery

Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. The typical training of an orthopedic foot and ankle surgeon consist of four years of college, four years of medical school, one year surgical internship, 5-6 years of orthopedic training and a 1 year fellowship in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school and 2-3 years of a surgical residency. One can also make the distinction between a podiatric and orthopedic foot and ankle surgeon: an orthopedic surgeon has a medical degree and training that encompasses both orthopedic and one year of training specific in techniques of foot and ankle surgery, while the training of a podiatrist consist of a podiatric medical degree and mandatory two or three year residency training specific to foot and ankle surgery.

CLINICAL SCOPE OF FOOT AND ANKLE SURGERY

Foot and ankle surgeons are trained to treat all disorders of the foot and ankle, both surgical and non-surgical. One is also trained to understand the rather complex connections between disorders and deformalities of the foot and ankle and the knee and hip and in return, the spine. Therefore, the surgeon will typically see cases that vary from trauma (such as malleolar fractures, tibial pilon fractures, calcaneus fractures, navicular and midfoot injuries and metatarsal and phalangeal fractures.) Arthritis care (primarily surgical) of the ankle joint and the joints of the hindfoot (tarsals), midfoot (metatarsals) and forefoot (phalanges)also plays a rather significant role. Congentital and acquired deformalities include adult acquired flatfoot, non-neuromuscular foot deformity, diabetic foot disorders, hallux valgus and several common pediatric foot and ankle conditions (such as clubfoot, flat feet, tarsal coalitions...etc.) Pateints may also be referred to a foot and ankle surgeon for proper diagnosis and treatment of heel pain (such as a consequence from plantar heel facitis), nerve disorders (such as tarsal tunnel syndrome) and tumors of the foot and ankle. Amputation and ankle arthroscopy (the use of a laproscope in foot and ankle surgical procedures) have emerged as prominent tools in foot and ankle care. A patient may also be referred to a foot and ankle surgeon for the surgical care of nail problems and phalangeal deformalities (such as bunions and buniettes.)

NON-SURGICAL TREATMENT OF FOOT AND ANKLE DEFORMALITIES AND CONDITIONS

The vast majority of foot and ankle conditions do not require surgical intervention. For example, several phalangeal conditions may be traced to the type of foot box used in a shoe, and a change of a shoe or shoe box may be sufficient to treat the condition. For flammatory processes such as rhuematoid arthritis, non-steroidal anti-inflammatories (NSAIDs) and Disease Modifying antirheumatic drugs (DMARDS) may be used to manage or slow down the process. Orthotics, or an externally applied devie used to modify the structural or functional characteristics of the neuromusculoskeletal system specifically for the foot and ankle may be used as inserts into shoes to displace regions of the foot for more balanced, comfortable or theraputic placements of the foot. Physical therapy may also be used to alleviate symptoms, strenthening muscles such as the gastrocnemius (which in return will pull on the achillies heel which will then pull on the plantar fascia thus changing the structure and shape of the foot).

SURGICAL TREATMENT OF FOOT AND ANKLE DEFORMATILITES AND CONDITIONS

Surgery is considered to be a last option when more conservative fails to alleviate symptoms (such as the above techniques outlined in the section above.) Such as bunionectomies may be used to surgically remove bunions and other foot and ankle deformalities, arthrodesis (or fusion of joint spaces) for inflammatory processes, and surgical reconstruction (i.e. invasive measures of manipulating neuromusculoskeletal structures) to treat other deformalities. One should note that orthotics, physical therapy, NSAIDs, DMARDs and a change of shoe will act in compliments to surgical intervention, and in most cases will be required for optimal recovery.

FOOT AND ANKLE PUBLICATIONS

As noted above, the last 50 years has shown high quality research into the etiology and management of foot and ankle deformalities. Several publications have been made to act as forums for such research:

The Journal of Foot and Ankle Surgery-A surgical journal operated by the American College of Foot and Ankle Surgery (a podiatry network.)

Foot and Ankle International- A surgical journal operated by the American Orthopedic Foot and Ankle Society (AOFAS), an orthopedic or M.D. ran organization.

Techniques in Foot and Ankle Surgery

OPEN-ACCESS FOOT AND ANKLE PUBLICATION

In January 2008, Al Kline DPM launched [The Foot & Ankle Journal]http://www.faoj.org. This is the first open access journal for podiatry and foot & ankle orthopaedics.

REFERENCES

Foot and Ankle: Core Knowledge in Orthopedics. 2007 Elsevier Mosby

Current Diagnosis and Treatment: Rheumatology, 2nd Edition. The McGraw-Hill Companies, Inc.

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