General Information about Foot and Ankle Arthroscopy

Orthopaedic surgery has advanced hugely in recent decades. The introduction of minimally invasive techniques such as arthroscopy has led to a number of techniques generated to treat many foot and ankle conditions. Arthroscopy, although now widely performed by most surgeons, really requires keen hand/eye coordination and dexterity to be able to perform the surgery swiftly, skilfully and successfully.

What exactly is arthroscopy? 

Arthroscopy is the technique that involves making tiny incisions to access the area of interest. Through these tiny incisions (often a total of 2 incisions per procedure), the surgeon inserts a thin metal tube (portal, less than half a centimetre wide) containing a camera connected to a television monitor in the operating theatre. This allows the surgeon to view the area or space where they will want to “work”, typically a joint such as the ankle. Through another tiny incision the surgeon inserts an “instrument”, again very thin in diameter, often a small high-speed burr or tissue cutting device. This way, by using both hands the surgeon can “work” inside the body space or joint, whilst looking at a monitor in the operating theatre. With skilled dexterity the operation can be performed successfully.

What foot and ankle surgery is performed with arthroscopy?

Many procedures are performed via arthroscopy. Your surgeon will explain to you whether or not your operation is possible to be done using this technique rather than through a more traditional, but still very successful, open incision approach.

Procedures include:

• Ankle joint fusion
• Subtalar joint fusion
• Subtalar joint inspection and debridement of inflamed/bone/scar tissue
• Ankle joint ligament inspection and debridement of ankle inflamed/bone/scar tissue from the front or the back of the ankle
• Ankle OCDs (osteochondral defects of joint surface) debridement
• Big toe joint (1^st MTP joint) inspection and debridement
• Achilles Tendon Tendoscopy – to inspect the tendon or remove scarring around the tendon
• Peroneal/Tibialis Posterior Tendon tendoscopy – to inspect the tendons or possibly remove small tendon tears or areas of tendon wear and tear

What are the advantages of arthroscopy?

• The scar over the operation site is typically far smaller than if the surgery was done via traditional open methods. This provides a large cosmetic benefit, important to many patients.
• In many orthopaedic operations there is good evidence to suggest the length of hospital stay post-operatively can be shorter after minimally invasive surgery.
• Although many operations used in foot and ankle surgery are day-case anyway, sometimes with “larger” operations hospital stays can be reduced.
• The healing and rehabilitation time and return to work can be significantly reduced with many operations done via arthroscopy.
• The outcome of many foot and ankle joint fusions procedures is improved with arthroscopic techniques. The bones are more likely to fuse successfully.

What are the disadvantages of arthroscopy? 

• Risk of inadvertent damage to important nerves to the skin and other blood vessels, but open surgery also carries risk to these.
• The technique can be challenging especially in repeated surgical cases or where deformity exists.
• The surgeon may have to convert to open surgical methods if attempted arthroscopy is difficult, but should warn you of this. This in itself is not a big risk, it really just prolongs your operation a little.
• Some surgeons think that arthroscopy does not enable you to see as much than during open surgery. This opinion is probably more related to surgeons skill and expertise. Arthroscopy actually can give you a fantastic view of the area being operated on.