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    Expert Advice from Methodist Professionals

    Ankle Fusion: What’s Old Is New Again

    By Michael O’Brien, M.D.

    When severe ankle pain affects your ability to walk and prevents you from doing the activities you want to do, a surgical procedure called ankle fusion may return you to a more active lifestyle.

            Before the advent of joint replacement, fusion was the primary surgical treatment for extremely painful ankles and other joints. For some patients, it is still the best option.

     
    Goals of Ankle Fusion

    Your orthopedic surgeon may suggest fusion when medications and other conservative treatments do not provide adequate relief. The goals of this surgery are to relieve pain, stabilize the joint, and restore function. Although joint fusion results in loss of mobility of the ankle, many patients have debilitating pain that has already caused some loss in their range of motion.

            Candidates for ankle fusion surgery typically include people who have severe ankle misalignment, which is commonly caused by a fracture or osteoarthritis. The procedure also may benefit people who want to participate in high impact sports, such as skiing, and it may be a good option for young patients. When fusion is successfully performed, it should last a lifetime – which may not be the case with an artificial joint.


    Inside the Ankle

                Three bones make up the ankle joint -- the lower end of the tibia, or shinbone; the fibula, a small bone in the lower leg; and the talus, the bone that fits into the socket formed by the tibia and the fibula. Ligaments on both sides of the ankle help hold these bones in place, and numerous tendons that cross the ankle help the joint and the toes move. (Ligaments connect bone to bone, and tendons connect muscle to bone.)

                A slick material called articular cartilage covers the ankle bones and allows them to move smoothly against one another. When the cartilage wears away, patients are left with a painful condition in which one bone rubs against another bone.


    Open & Arthroscopic Surgery

    The two basic procedures for fusing an ankle are traditional open surgery and the newer arthroscopic technique. The orthopedic surgeon will determine which procedure is most appropriate for you based on your medical history, current health, the condition of your ankle, and other factors.

            The most common way to perform open surgery is to make an incision, open the joint, and clean away articular cartilage surfaces from the ankle, which will allow the tibia and the talus bones to fuse or grow together. The surgeon then inserts pins, rods or plates to immobilize the bones and prevent additional damage to the joint. In some cases, surgical pins are inserted inside the leg and ankle, and a metal rod and pins are placed on the outside. More commonly, only internal plates and screws are used.

            During arthroscopic surgery, the orthopedic surgeon makes several small incisions and inserts an instrument called an arthroscope, which contains a tiny camera.  With the arthroscope and other surgical instruments, the surgeon can visually monitor progress as he or she treats the joint. As with the open method, screws or pins are used to hold the bones together.


    Recovery & Rehab

                Following surgery, you can expect to wear a padded plaster cast, which will be removed in approximately two weeks and replaced with a short-leg cast. After eight to 12 weeks, the shorter cast will be replaced by an ankle brace.

            You should avoid putting weight on the affected ankle during this time. As the ankle heals, you may work with a physical therapist to regain your ability to walk smoothly, without a limp. Once the bones have fused and completely healed, you may be fitted for a shoe insert to make walking easier, or you may simply wear flat shoes.

     

    About the Author: Michael O’Brien, M.D., is a board certified orthopedic surgeon on the staff of Methodist Medical Center of Oak Ridge. He is in practice with Orthopaedic Surgeons of Oak Ridge. Dr. O’Brien earned his medical degree from St. Louis University of Medicine in St. Louis, Mo., and completed an orthopedic surgery residency at William Beaumont Hospital. He is a member of the American Academy of Orthopaedic Surgeons.

    Monday, November 30, 2009 - Living an Independent Life: Cardiac Rehab

    Cardio RehabWith each passing year, millions of Baby Boomers join the ranks of senior citizens. Many of them are accustomed to living active lives, and losing their ability to live independently is a major concern.
        
    Methodist Medical Center of Oak Ridge is offering a series of articles called “Living an Independent Life.” These articles are intended to provide seniors and their families with information to help them enjoy a better quality of life through better health.

    In this article, Sharon Ollis, manager of Methodist’s cardiopulmonary rehabilitation program, discusses the role of cardiac rehab in helping people with certain heart conditions enjoy a better quality of life.

    What is the purpose of cardiac rehab?
    Sharon Ollis: Cardiac rehab is an individualized plan of exercise and education for patients with certain heart conditions who have been referred by their doctor.

    Doctors may refer patients who have had a heart attack, coronary artery bypass surgery, coronary angioplasty, coronary stenting, heart valve repair/replacement or heart transplant. Other patients that may benefit are those whose medical history includes certain heart diseases present at birth, coronary artery disease, angina, peripheral artery disease, congestive heart failure or cardiomyopathy.
        
    The goals of cardiac rehab are to help patients regain strength, prevent their condition from becoming worse, and reduce the risk for other heart problems in the future. The main components of the program are medical evaluation, prescribed exercise, cardiac risk factor modification, education and psychosocial support.

    What can patients expect during rehab?
    Sharon Ollis: There are three phases of rehab: hospitalization, early recovery, and long-term recovery. Hospitalized patients may begin cardiac rehab with non-strenuous activities such as sitting up in bed, doing range-of-motion exercises, and walking. During early recovery, which may last from two to 12 weeks, patients gradually increase their activity level under the close supervision of cardiac rehab specialists. They also may do moderate exercises at home. Long-term cardiac rehab may continue for the rest of a patient’s life. It may include exercise at home and at a cardiac rehab center, along with continuing education on diet, weight loss, and lifestyle choices.

    Initially, patients undergo a thorough medical assessment to assess their medical limitations, overall health, and physical capabilities. Assessments include an evaluation of a patient’s cardiac risk factors such as high blood pressure, diabetes and other conditions that lead to cardiovascular disease.
        
    Cardiac rehab improves a patient’s cardiovascular fitness through physical activities such as walking, cycling and other aerobic exercise. It also may consist of exercises to increase muscular strength.
        
    Lifestyle education includes information on diet and nutrition. The goal is to help patients choose healthier foods and reduce their fat, cholesterol, and salt intake. Patients also receive guidance on stress management, medication, smoking cessation and making other healthy choices that affect their cardiovascular system.
        
    People often experience anxiety and depression after having a heart attack or receiving a diagnosis of heart disease. A cardiac rehab program helps them find ways to cope and rebuild their lives, and it gives them opportunities to meet and share their concerns and triumphs with people in similar circumstances.

    To achieve the best possible outcome, patients may work with cardiologists, nurse educators, dietitians, pharmacists, exercise rehab specialists, occupational therapists, physical therapists, and mental health professionals, as needed.

    What can people do to reduce their risk factors for heart disease?
    Sharon Ollis: Smoking cessation is extremely important for patients who smoke. When someone decides to quit, it’s a good idea for them to change routines that trigger their urge to smoke, stay away from other people who smoke, substitute low calorie snacks or gum for cigarettes, join a smoking cessation class or support group, and take it one day at a time.

    Dietary changes vary depending on each individual patient’s needs, but in general, they include eating less red meat and dairy products; baking, broiling, steaming or grilling foods rather than frying; and reading labels for fat content.

    Patients should check with their doctor before starting an exercise program at home. When starting an exercise program, begin slowly and gradually increase time and intensity. Aerobic exercises such as walking or cycling are good choices. The person should stop exercising if he or she experiences chest pain; pain that radiates into the neck, shoulder or arm; increased shortness of breath; irregular heartbeat; or excessive sweating. If any of these symptoms continue, call the doctor.

    Controlling stress is also important. Patients should identify things that cause stress, learn stress management and relaxation techniques, get plenty of rest, and pace themselves.


    Sharon OllisAbout the Author: Sharon Ollis, RRT, MS, is manager of cardiopulmonary rehabilitation at Methodist Medical Center of Oak Ridge. She earned an associate of science degree in respiratory therapy from Cleveland State Community College, as well as a bachelor of science in health arts and a master of science in health services administration from University of St. Francis in Joliet, IL. Ollis has 18 years of experience in cardiac rehabilitation.