Arthroscopy subtalar joint
The subtalar joint is in the hindfoot between the ankle and the heel. It enables the foot to pivot sideways so that it can tilt to adapt to uneven ground when walking. It can become damaged or arthritic, like any other joint. Keyhole surgery of a joint is called arthroscopy. Most people are familiar with this being carried out on the knee joints but not everyone is aware that foot and ankle orthopaedic surgeons routinely do the same for joints in the foot. Such keyhole surgery offers advantages over conventional open surgery including more rapid recovery and improved visualisation for the surgeon since everything is magnified and brightly lit on the television screen. The joint can develop bony spurs, frayed and loose cartilage or inflamed, scarred joint lining tissue (synovium) which catches in certain positions. Such problems can be assessed and usually treated arthroscopically.
The surgery is normally carried out under general anaesthetic supplemented by local anaesthetic to ensure good post-operative pain relief. Most procedures are carried out as a daycase. There are usually two incisions, each about 1cm long. One is at the side of the ankle and the other further back near the Achilles tendon. The joint is filled with fluid during the operation and drained off at the end. The length of time taken depends on the work required. Sometimes it is straightforward removal of some soft tissue (taking only half an hour or so) whereas sometimes lots of work is necessary to remove various bony spurs and damaged cartilage taking well over an hour. The amount of work will also determine how long it takes to return to normal walking and activities. Although on the outside there are only two small incisions to see (usually 1 stitch required for each) there might have been substantial surgical work carried out on the inside.
At the end of the procedure each is closed with a nylon suture and covered with an adhesive dressing. A bandage is applied for comfort. This can be self-removed after 5 days and the stitches removed after 10-11 days by the day ward, district nurse or you practice nurse. Although you are given crutches to take home, it might be safe to fully weight bear as soon as the foot is sufficiently comfortable. This depends on exactly what was done inside the joint. Sometimes it is important to allow the joint surface to heal over with a new cartilage layer by keeping to the crutches and limiting weight bearing for several weeks. Your surgeon will give you precise information.
The time taken for symptom to settle varies. In the case of removal of inflamed tissue in an otherwise healthy joint, walking and activities can return to normal in a week or two, sometimes even before the stitches are due for removal. Often however patience is required and although the sharper pains might disappear very quickly the original pains can take 2-6 months to fully settle, again depending on the underlying problem and the surgery required to treat it. We will do our best to predict for you what you can expect.