Foot and ankle surgery is a sub-specialty of

orthopedics Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

and

podiatry Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and leg. A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a healthcare p ...

that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school or osteopathic medical school to obtain an

M.D. Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. T ...

D.O. Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licens ...

followed by specialist training as a resident in

orthopaedics Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

, and only then do they sub-specialise 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 ( D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship. The distinction between a podiatric and orthopedic foot and ankle surgeon is: an orthopedic surgeon has a

Doctor of Medicine Doctor of Medicine (abbreviated M.D., from the Latin language, Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a profes ...

Doctor of Osteopathic Medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licens ...

medical degree or osteopathic medical degree and training that encompasses both orthopedic residency and an optional 6-month to one year of fellowship training specific in techniques of foot and ankle surgery, while the training of a

Doctor of Podiatric Medicine A podiatrist ( ) is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for ...

consist of a podiatric medical degree and three to four-year residency training specific to foot and ankle medicine and surgery, with an optional additional 1-year fellowship in foot and ankle trauma, reconstruction, or diabetic limb salvage. In the UK much controversy exists on the scope of podiatrists practicing surgery and the

British Orthopaedic Association The British Orthopaedic Association is a professional association in Britain for doctors who specialize in orthopaedic surgery. History The British Orthopaedic Association was founded in 1918. One of the founders was Harry Platt, who went on t ...

, and the British Orthopaedic Foot and Ankle Society produced
position statement
on the importance of training and ongoing regulation of podiatrists practising podiatric forefoot surgery after certification and recommended that this should be to the same standard as that of medically qualified trauma and orthopaedic surgeons operating on the foot and ankle.

Clinical scope

Foot and ankle surgeons are trained to treat all disorders of the foot and ankle, both surgical and non-surgical. Additionally, the surgeons are also trained to understand the complex connections between disorders and deformities of the foot, ankle, knee, hip, and the spine. Therefore, the surgeon will typically see cases that vary from trauma (such as malleolar fractures, tibial

pilon fracture A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. ...

s, 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. Congenital and acquired deformities 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 coalition Tarsal coalition is an abnormal connecting bridge of tissue between two normally-separate tarsal bones. The term 'coalition' means a coming together of two or more entities to merge into one mass. The tissue connecting the bones, often referred ...

s, etc.) Patients 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 fasciitis), nerve disorders (such as tarsal tunnel syndrome) and tumors of the foot and ankle. Amputation and ankle arthroscopy (the use of a laparoscope in foot and ankle surgical procedures) have emerged as prominent tools in foot and ankle care. In addition, more applications for

laser surgery Laser surgery is a type of surgery that uses a laser (in contrast to using a scalpel) to cut tissue. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft-tissue laser surgery, in which the laser beam vapori ...

are being found in the treatment of foot and ankle disorders, including treatment for

bunions A bunion, also known as hallux valgus, is a deformity of the metatarsophalangeal joint, joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typ ...

and soft tissue lesions. A patient may also be referred to a foot and ankle surgeon for the surgical care of nail problems and phalangeal deformities (such as bunions and bunionettes.)

Non-surgical treatments

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 inflammatory processes such as

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involv ...

, non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDS) may be used to manage or slow down the process.

Orthotics Orthotics ( el, Ορθός, translit=ortho, lit=to straighten, to align) is a medical specialty that focuses on the design and application of orthoses, or braces. An is "an externally applied device used to influence the structural and functio ...

, or an externally applied device 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 therapeutic placements of the foot. Physical therapy may also be used to alleviate symptoms, strengthening muscles such as the

gastrocnemius The gastrocnemius muscle (plural ''gastrocnemii'') is a superficial two-headed muscle that is in the back part of the lower leg of humans. It runs from its two heads just above the knee to the heel, a three joint muscle (knee, ankle and subtalar ...

muscle (which in turn will pull on the heel, which will then pull on the plantar fascia, thus changing the structure and shape of the foot).

Surgical treatments

$X ray internal fixation leg fracture$ Surgery is considered to be a last option when more conservative approaches fail to alleviate symptoms. Techniques such as bunionectomies may be used to surgically remove bunions and other foot and ankle deformalities,

arthrodesis Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones by surgery. This is done to relieve intractable pain in a joint which cannot be managed by pain medication, spli ...

(or fusion of joint spaces) for inflammatory processes, and surgical reconstruction (i.e. invasive measures of manipulating neuromusculoskeletal structures) to treat other deformalities. Orthotics, physical therapy,

NSAID Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...

DMARD Disease-modifying antirheumatic drugs (DMARDs) comprise a category of otherwise unrelated disease-modifying drugs defined by their use in rheumatoid arthritis to slow down disease progression. The term is often used in contrast to nonsteroidal ...

s and a change of shoe may act as a complement to surgical intervention, and in most cases will be ''required'' for optimal recovery.

Publications

The last 50 years has shown high quality research into the etiology and management of foot and ankle deformities. Several publications have been made to act as forums for such research: * ''Journal of the American Podiatric Medical Association'' - a peer reviewed indexed medical journal * ''The Journal of Foot & Ankle Surgery'' - a surgical journal operated by the American College of Foot and Ankle Surgeons * ''Foot and Ankle International'' - a surgical journal operated by the American Orthopaedic Foot and Ankle Society (AOFAS). * ''Techniques in Foot & Ankle Surgery'' * ''The Foot & Ankle Journal'' - The Foot & Ankle Journal
/ref> the first open access journal for podiatry and foot & ankle orthopaedics.

References

{{reflist * Foot and Ankle: Core Knowledge in Orthopedics. 2007 Elsevier Mosby * Current Diagnosis and Treatment: Rheumatology, 2nd Edition. The McGraw-Hill Companies, Inc. Surgery Podiatry Orthopedic surgical procedures

Clinical scope

Non-surgical treatments

Surgical treatments

Publications

See also

References