Posterior Hindfoot Endoscopy
One of the big changes in surgery in the last two decades has been the introduction of keyhole surgery. As techniques and technology improve the advantages have been applied to an expanding number of situations. If performed in a joint, keyhole surgery is called arthroscopy. The more general term of endoscopy simply means looking inside.
At the back of the ankle joint are several areas which can give rise to pain. These include wear and tear changes and several recognised bony projections or bumps. These can rub against one another in certain foot positions or cause friction against a tendon. Once the problem has been identified it can usually be treated successfully by removal or 'tidying up' (debridement) of the affected area. In the last few years techniques have been developed to do this through small incisions at the back of the ankle joint using fibre optic scopes and cameras. This offers the advantage of avoiding a large incision which adds to the recovery period and gives the surgeon a magnified view superior to that seen with conventional surgery.
Most of this surgery is done under general anaesthetic supplemented by local anaesthetic block to the nerves to give good post-operative pain relief. Most patients go home the same day or perhaps after one over night stay. Usually two 1cm incisions are made, one each side of the Achilles tendon - the exact position depending on the condition being treated. Small power shavers slimmer than a ball point pen are used to remove fibrous tissue, bony spurs or frayed cartilage. For most conditions a plaster cast is not required and although crutches are provided the patient is normally allowed to take as much weight as comfortable. Your surgeon will provide a detailed post-operative schedule specific to your problem and its treatment.
It is important to understand that although on the surface only two small scars are evident, often substantial surgery has occured inside and it might be several weeks or months before the full benefit is apparent. We will always do our best to predict this for you based on past experience. Swelling in particular is often slow to fully recover, being more noticable at the end of the day. Physiotherapy is often very important to ensure the joints recover fully with no excessive tightness.