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Advances in Outpatient Foot and Ankle Surgery
New techniques, premium power tools and improved pain management help surgeons achieve excellent outcomes through smaller incisions.
Daniel Bohl, MD
Publish Date: September 21, 2021   |  Tags:   Pain Management Wound Closure Orthopedics
POKING AROUND Emerging minimally invasive techniques result in less post-op pain and smoother recoveries than traditional open procedures.

Minimally invasive techniques, premium power tools and innovative multimodal pain management practices are helping surgeons repair a number of foot and ankle problems that result in less post-op pain, earlier ambulation and positive outcomes. These four procedures in particular are becoming more popular in outpatient ORs:

Ankle ligament reconstructions. Lateral ligament instability via direct repair of the ligament using suture only is normally sufficient, but less effective in patients with failed index repairs or particularly weak ligaments. Newer anchor-to-anchor suture construct technology allows surgeons to use a strong nonabsorbable permanent suture that is directly anchored to the two bones they’re trying to hold together. One anchor is placed in the fibula, the other is placed in the talus and a permanent suture connects those two anchors that substitutes for the ligament.

Minimally invasive bunionectomies. Several companies have recently introduced minimally invasive techniques to correct bunions that result in small incisions, decreased postoperative pain and improved cosmesis. These techniques are performed through two to three tiny poke holes in the foot of less than 0.5 cm each. The surgeon then uses low-speed, high-torque burrs to straighten and remove the bunion bone.

Achilles tendon repairs. The surgery is performed through a much smaller incision using a minimally invasive technique where the surgeon makes a single 1 cm to 2 cm incision on the posterior aspect to the ankle and passes the sutures in a percutaneous manner, minimizing the surgical exposure. The smaller incision decreases the potential for infection and increases the potential for successful wound healing.

Fixation of osteoporotic ankle fractures. There’s been a game-changing technology introduced into orthopedics called the locking screw. With this technology, the screw binds to the plate at a fixed 90-degree angle, which creates a construct that is far superior biomechanically, in that the plate and screw are able to hold weak osteoporotic bone with great strength. These locking screws have enabled surgeons to fix osteoporotic ankle fractures with much greater predictability and success. 

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