Here's a question for the surgery bofs
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I have a patient, male 56 years old, who 15 years ago fractured both ankles in a motor bike accident. He now suffers severe 'ankle' pain during ambulation bilateral but worse l/f.
He has recently been thru the medical route and only has analgesia and anti imflammatories as a result.
In his biomechanical exam I noted that the left STJ was rigid and the right was reasonably normal in quality and range of movement. Left and right mid foot rom was restricted in both feet but worse l/f. I ordered x rays, which showed complete degeneration of the l/f STJ and substantial degeneration of the r/f stj. Right mid foot had mild degeneration and left mid foot had severe degeneration with no distiction of joint space in any joint. Both talo-crural joints are in good condition and have good clinical presentation and RoMs.
I propose to fit soft accomodative orthoses to reduce moments about the STJ and increase shock attenuation in addition to rocker type shoes to reduce dorsiflexion moments about the midtarsal joint.
I have advised referal to orthopaedics with a view to surgery in the future, possibly arthrodesis. What type of surgery would you envisage, if any.
Cheers Dave Smith
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