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ANKLE IMPINGEMENT

Pain in the ankle can be related to various problems.  This can be related to bone spurs at the front of the ankle, inflammatory tissue or scar tissue related to an underlying condition such as arthritis or, related to previous injuries.  Often bracing, strengthening the ankle, pain medications and adjusting your activites may be enough.  If you're still having problems despite these measures, you may be a candidate for restorative and minimally invasive options such as biologic injections or nanoarthroscopy or ankle arthroscopy. 

NANOARTHROSCOPY

Sometimes pain can persist despite doing all the right things.  It isn't uncommon to have a painful ankle long after an initial ankle sprain that just won't get better despite trying all the right things.  At this point often after 8-12 months have passed, an MRI may be ordered to look for an underlying cause for pain.  In this situation, the MRI may show only mild or even no findings despite ongoing pain.  In these cases, a minimally invasive approach with a Nanoscope can help determine the underlying diagnosis and guide next steps in treatment.  In some cases, treatment can also be performed in the same nanoscope procedure.  This is a procedure done just under freezing with a small "needle arthroscopy" allowing you to walk away with less procedure pain and a less involved recovery than a traditional arthroscopy. 

ANKLE ARTHROSCOPY & DEBRIDEMENT

An ankle arthroscopy is a procedure performed in the operating room.  During this same day procedure, a camera is placed through two small incisions on the front of your ankle.  Dr. Roberts will assess the inside of your ankle and treat any problems.  This can include removing scar tissue, inflamed tissue or bone spurs.   Ankle arthroscopy can also be used during surgery to address ankle instability or cartilage problems.  

ANKLE ARTHROSCOPIC DEBRIDEMENT
POST OP INSTRUCTIONS

FOLLOW UP:

  • First appointment: approximately 2 weeks from surgery, usually at the Burnaby Hospital Fracture Clinic.

  • Prior to your surgery, you should have received dates for your 6 week and 3 months follow up visits. 

  • You will typically arrange a follow up one year from surgery as well for final xrays. 

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EXPECTED RECOVERY TIMELINE:

  • Swelling and pain is normal and expected in the first two weeks.  Rest, elevation and pain medication are important to help manage this. 

  • If your pain is severe and you aren't managing with the instructions and pain medication provided, call or go to the Burnaby Emergency Department.

  • Ideally by 3 months following surgery, you are walking not necessarily far, or fast but able to get back to your normal day to day in a more normal shoe.

  • Swelling is normal and not a concern and can last for up to 6-12 months.  Some swelling doesn't always resolve fully.

  • If all is healing well, you can progress your walking and other physical activity as your symptoms allow. 

  • You will not know full recovery (pain, swelling, strength) until 9-12 months following surgery.  

 

DRESSING:

  • You will typically  go home from surgery with a post op boot on your foot and ankle.

  • Once your freezing has worn off, you can take the boot off to ice and move the ankle.  The boot should stay on to sleep until your first follow up.

  • After your first appointment, once your wound has healed adequately, you can often begin to transition to a shoe as your symptoms allow.

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WOUND:

  • Your wound(s) are closed with sutures, some of which will need to be removed.  

  • Do not get the dressing or wound wet for the first 2 weeks.  To ensure this, a bag should be placed over the let to avoid anything getting wet.  

  • You'll have a dressing on that can stay on until your 2 week appointment or, if you so choose you can take this down and apply a lighter dressing after 5 days or so. 

  • Sutures are removed typically at the 2 week mark. 

  • After your sutures are removed, you can shower 2-3 days later and allow clean water to run over the wounds.  Pat this dry and reapply a dressing if it is your preference. It is not required.  The steristrip tapes on your wound can get wet.  Just pat them dry. 

  • Steristrips should stay on for about 10-14 days usually.  If they fall off prior to this, they do not need to be reapplied.  If they are still on after 14 days, ensure you please remove them yourself. 

  • Do not immerse the wound in a bath, hot tub or pool until the scar is fully healed with no scabs.  This is often 4 weeks. 

  • No lotions or creams should be used until the wound is fully healed, often 4-6 weeks. 

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WEIGHTBEARING 

  • As long as you haven't had additional work done (cartilage or ligament work) you may put full weight on the foot in the boot after 2-3 days. 

  • As soon as you are able after surgery you can transition to a shoe as able.  Keep in mind some people still have too much swelling at this point to be able to get into the shoes they want just yet.

 

PHYSIOTHERAPY:

  • At the 1-2 week mark, if you feel able, you may begin physiotherapy.  Prior to this due to swelling, wounds and dressings, possibly therapy will be limited.  

  • Dr. Roberts will provide you a custom physiotherapy prescription to help guide your therapist in your recovery. 

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DRIVING:

  • You are not able to drive if you are still taking Opioid (Narcotic) pain medication

  • Left foot surgery: beginning at least 2 weeks post op, once you are able to comfortably remove the sandal/boot while driving.  Contact your insurance for further recommendations.

  • Right foot surgery:  You can drive once you are walking fully in a shoe.

  • Try practicing in a parking lot first to ensure your reaction/strength/motion is adequate 

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FLYING:

  • If possible, you should consider avoiding long haul flights for the first 4-6 weeks from surgery.

  • If you must fly before this there is an increased risk of blood clot.  Try to keep moving on the flight, stay hydrated, avoid alcohol, consider compression socks.  Discuss with Dr. Roberts if you require a blood thinner to keep your risk as low as possible. 

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WORK:

  • You should arrange to be off of work for the first 2 weeks after surgery to allow for rest and recovery.

  • If you are working from home or can get to work safely and work in a flexible seated job, you could return to work after the first week if you so choose, provided you are off opiod (narcotic) pain medication.  You will need to elevate the foot and allow for more breaks. More commonly, most patients take 6 weeks off work. 

  • Any work should be sedentary for the first 8-12 weeks.

  • Typically a return to more physical duties can begin gradually at the 12 week mark from surgery. 

  • You may discuss your return to work plan with Dr. Roberts if you still have questions.

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