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Ankle Synovitis- coming soon

What Is Ankle Synovitis?

What Can Cause It?

What Are The Symptoms?

Pain is by far the commonest symptom. Pain may be felt in the “ball” of the 2nd toe joint, on the plantar (sole) aspect of the foot. Pain may also be felt across the dorsum (top) of the foot at the 2nd MTP joint.

Swelling may be present particularly as the condition progresses, and there may be increased warmth in the joint.

Examination initially may reveal nothing but tenderness across the 2nd MTP joint. As the disease progresses swelling can occur, and the 2nd toe starts to drift (medial) towards the big toe. Later the 2nd toe crosses over or under the big toe. Thickening of the skin (callosity) under the 2nd MTP joint is typically a manifestation of increased load and forces going through the joint. The callosity maybe painful and attempts to remove it will be temporary as the skin will thicken again in response to the abnormal load.

What Investigations May Be Required?

Can The Problem Get Worse?

Non-Operative Treatment Options

Operative Treatment Options

Potential Complications

Potential complications of non-operative treatment include:

  • Worsening pain
  • Increasing deformity
  • Dislocation of 2nd toe
  • Formation of ulcers on the sole of the foot (plantar aspect of 2nd MTP joint)
  • Formation of ulcers across the top (dorsum) of the second toe as it rubs against the shoe
  • Infection of ulcers

Complications can occur as with any type of surgery. Please see Complications for more detailed explanation of post surgical complications.

Potential complications of operative treatment include:

  • Risks and complications of anaesthesia
  • Bleeding
  • Infection (superficial and deep)
  • Blood clots
  • In the case of an MIS procedure it may be necessary to proceed to open surgery if during the operation it is felt that a better outcome will be achieved using an open technique
  • Failure to fully correct deformity (particularly if longstanding deformity)
  • Recurrence of the deformity
  • Stiffness of the 2nd MTP joint
  • Wound healing problems (particularly when correcting a chronic dislocation the soft tissue can become contracted)
  • Compromise to the blood supply (particularly when correcting a chronic dislocation the blood vessels can become contracted)
  • Need for further surgery

Note these lists are not exhaustive.

Post Operative Period & Recovery

Please read the information regarding what to expect post surgery on this website.

Remember that below is a guide to recovery and that everyone heals at different rates and some people do take longer. Use this information to help you understand your condition, possible treatment and recovery. The timeframes given below are a minimum, it is important that you appreciate this when considering surgery as your healing and recovery may take longer.


Immediate post operative period

Almost all surgical procedures for 2nd metatarsal instability will be undertaken as a day case.

You will have a bandage applied similar to this during the operation.

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Please do not remove your bandages until you are seen by your surgeon Mr Malik at the two week post operative clinic appointment. You will also be provided with a post operative shoe. Please ensure you wear this whenever you are weight bearing.

For the first 48 hours you will be allowed to touch weight bear using two crutches. After 48hrs you can weight bear as tolerate. The physiotherapist will guide you after your operation and before your discharge from hospital.

For the first two weeks following your surgery please keep your foot elevated to the level of your heart for 95% of the time.

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Naturally most people do not have a hospital bed at home. The same effect can be achieved by lying in a bed or lengthways on a sofa, with pillows behind your back and under your foot. You cannot have your leg elevated sitting in a chair. It is strongly advised that during the first two weeks you are house bound.

To minimise risk of infection keep the foot dry and cool. Avoid humid and hot environments. Keep the foot dry and when showering wear a Limbo bag.

To minimise the risk of blood clots please move your foot and ankle at regular intervals. Please ensure you are well hydrated. If you have a risk of blood clots please notify Mr Malik who may organise for you to have blood thinning injections as a precaution.


Two weeks post operatively

You will be reviewed at the clinic and your dressings removed. Your wound will be checked and your toe taped or strapped.

IMG_2993

An example of taping of the foot to help maintain the surgical correction and allow the structures to heal in the correct position.

At this stage if the swelling has subsided sufficiently you will be advised to keep your foot in an elevated horizontal position (50-75% of the time). You will require to wear the special post operative shoe for another 4 weeks. Short trips can be made outside, within limits of pain and swelling.

Driving will be permitted for short trips if the left foot has been operated on and you drive an automatic. If the right foot has been operated on it will be at least 6 weeks before any driving is advisable.

Scar desensitisation should start as soon as the wound has completely healed. You can do this by massaging cream (E45 for example) into the scar and around the wound area.

Commence exercises of the lesser toes 3 weeks after surgery and continue for 3 months. These exercises included active resistive and passive toe flexion and extension. They also include intrinsic foot muscle strengthening exercises.


Six weeks post operatively

You will have radiographs taken just before you are seen in clinic. You will go over these with Mr Malik and compare the before and after images. If you have had a bony procedure, it will take a minimum of 6 weeks to heal.

At this stage if your healing is progressing satisfactorily swelling and bruising should have subsided considerably, although expect some degree of swelling for at least 3 to 4 months.

You will be able to start wearing normal footwear (swelling permitted), although stiff soled shoes are advisable. Continue to do the lesser toe exercises for another 6 weeks.


Three months post operatively

Final clinical examination. Discharge if satisfactory.


FAQs

When can I drive?

Please see guidance above and information here. Ultimately it is the responsibility of the patient to decide if they are safe to drive. A good way of knowing is if you can stamp your right foot heavily on the ground to mimic an emergency brake. If you have any hesitation or pain then it should suggest you are not safe to drive. Remember prolonged driving involves keeping your feet in a dependant position. This will worsen the post operative swelling.

When can I return to work?

This really depends on you and your job. If you have a job that involves a lot of standing, walking and is manual it may be 8 to 12 weeks. If you have a sedentary job, for example in an office and you have a reasonable commute you may be able to go back to work at 2 weeks, although this would be exceptional and not the norm.

What should the final outcome be?

Excellent pain relief and deformity correction. Ability to participate in sports by 6 months. Sometimes up to a year before the foot feels “normal” and fully healed.

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