Our office specializes in treating, preventing, and repairing injuries & defects of the foot and ankle.
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Arthroscopy & Tendoscopy of the Foot & Ankle
We apply arthroscopy & tendoscopy for many pathologies including:
- Ankle joint (osteochondral lesions, arthritis, fractures, ligament injuries, posterior ankle impingement)
- Subtalar joint (arthritis)
- Metatarsal phalangeal joint (Hallux rigidus)
- Peroneal tendons
- Posterior tibial tendon
- Flexor halluces longus tendon
- Achilles tendon (Haglund’s deformity, Achilles tendinosis)
Depending on the size and characteristics of your Osterochondral lesion, we have two different treatment options:
1. Reparative Treatment – Bone marrow stimulation (Microfracture)
2. Replacement Treatment – Autologous osteochondral transplantation (OATS)
Yasui Y, Ross AW, Kennedy JG. Platelet-Rich Plasma and Concentrated Bone Marrow Aspirate in Surgical Treatment for Osteochondral Lesions of the Talus. Foot Ankle Clin. 2016 Dec;21(4):869-884.
Flynn S, Ross KA, Hannon CP, Yasui Y, Newman H, Murawski CD, Deyer TW, Do HT, Kennedy JG. Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus. Foot Ankle Int. 2016 Apr;37(4):363-72.
Fraser EJ, Harris MC, Prado MP, Kennedy JG. Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population. Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1272-9.
Haleem AM, Ross KA, Smyth NA, Duke GL, Deyer TW, Do HT, Kennedy JG. Double-Plug Autologous Osteochondral Transplantation Shows Equal Functional Outcomes Compared With Single-Plug Procedures in Lesions of the Talar Dome: A Minimum 5-Year Clinical Follow-up. Am J Sports Med. 2014 Aug;42(8):1888-95.
Murawski CD, Kennedy JG. Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2013 Jun 5;95(11):1045-54.
In the great majority of cases, individuals who see a physician for their injury are instructed on how to reduce pain and inflammation. They may be advised to wear an air cast or participate in physical therapy to strengthen the ankle muscles, in order to make a full recovery.
The remaining population—about 10% of people—develop ankle instability, a condition in which, although the ligament has healed, it has done so in a lengthened position. As a result, the person is prone to a feeling of the ankle “giving out” and to additional sprains. Athletes such as ballet dancers, who already have looser-than-average ligaments, are particularly likely to develop this condition.
Surgical treatment is reserved for patients who have persistent symptoms despite functional treatment. Surgery is often achieved with anatomic ligament repair (modified Bröstrum procedure) but some patients require ligament reconstruction using free tendon grafts. We have developed a novel method of hybrid reconstruction using the peroneal longus tendon.
Sports Injuries to the Foot & Ankle
Zwiers R, Wiegerinck JI, Murawski CD, Fraser EJ, Kennedy JG, van Dijk CN. Arthroscopic Treatment for Anterior Ankle Impingement: A Systematic Review of the Current Literature. Arthroscopy. 2015 Aug;31(8):1585-96.
Murawski CD, Kennedy JG. Percutaneous internal fixation of proximal fifth metatarsal jones fractures (Zones II and III) with Charlotte Carolina screw and bone marrow aspirate concentrate: an outcome study in athletes. Am J Sports Med. 2011 Jun;39(6):1295-301.
Yasui Y, Hannon CP, Hurley E, Kennedy JG. Posterior ankle impingement syndrome: A systematic four-stage approach. World J Orthop. 2016 Oct 18;7(10):657-663.
Smyth NA, Zwiers R, Wiegerinck JI, Hannon CP, Murawski CD, van Dijk CN, Kennedy JG. Posterior hindfoot arthroscopy: a review. Am J Sports Med. 2014 Jan;42(1):225-34.
Smyth NA, Murawski CD, Levine DS, Kennedy JG. Hindfoot arthroscopic surgery for posterior ankle impingement: a systematic surgical approach and case series. Am J Sports Med. 2013 Aug;41(8):1869-76.
Zwiers R, Wiegerinck JI, Murawski CD, Smyth NA, Kennedy JG, van Dijk CN. Surgical treatment for posterior ankle impingement. Arthroscopy. 2013 Jul;29(7):1263-70.
Tendon Injuries to the Foot & Ankle
Kennedy JG, van Dijk PA, Murawski CD, Duke G, Newman H, DiGiovanni CW, Yasui Y. Functional outcomes after peroneal tendoscopy in the treatment of peroneal tendon disorders. Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1148-54.
Yasui Y, Tonogai I, Rosenbaum AJ, Moore DM, Takao M, Kawano H, Kennedy JG. Use of the arthroereisis screw with tendoscopic delivered platelet-rich plasma for early stage adult acquired flatfoot deformity. Int Orthop. 2017 Feb;41(2):315-321.
Gianakos AL, Ross KA, Hannon CP, Duke GL, Prado MP, Kennedy JG. Functional Outcomes of Tibialis Posterior Tendoscopy With Comparison to Magnetic Resonance Imaging. Foot Ankle Int. 2015 Jul;36(7):812-9.
Ling JS, Ross KA, Hannon CP, Egan C, Smyth NA, Hogan MV, Kennedy JG. A plantar closing wedge osteotomy of the medial cuneiform for residual forefoot supination in flatfoot reconstruction. Foot Ankle Int. 2013 Sep;34(9):1221-6.
Arthritis of the Foot & Ankle
The gold standard of surgical treatment of advanced ankle arthritis is traditionally fusion of the ankle joint. The arthrodesis can be performed arthroscopically with minimal invasive incision. Arthroscopic arthrodesis allows patients to quickly rehabilitate and fusion rates are comparable or better than a traditional open procedure.
Distraction arthroplasty with a external fixator is also an option. This technique stretches the joint apart for a period of time with a frame and unloads the ankle joint, allowing healing of the damaged joint. This can be helpful in patients in whom it is desirable to prolong the need for fusion or replacement.
After a blood sample is obtained from a patient, the blood is put into a centrifuge, which is a tool that separates the blood into its many components. Platelet rich plasma can then be collected and treated before it is delivered to an injured area of bone or soft tissue, such as a tendon or ligament.
PRP is given to patients through an injection, and ultrasound guidance can assist in the precise placement of PRP. After the injection, a patient must avoid exercise for a short period of time before beginning a rehabilitation exercise program.
Stem cells can be used to help with bone healing, cartilage repair and new blood vessel growth. Using stem cells may treat delayed union or nonunion of bone fractures, cartilage defects, osteonecrosis, chronic tendon problems or chronic wounds.
Shockwave therapy is a non-invasive method that uses pressure waves to treat various musculoskeletal conditions. This causes blood vessel formation and increased delivery of growth factors to the affected area to stimulate the repair process and relieve pain. Shockwave therapy is not painful and takes only 5 minutes. Shockwave therapy has been used for treatment of a variety of conditions including: Plantar fasciitis, Achilles tendinosis, Peroneal tendinosis, Posterior tibial tendinosis, stress fracture, and various kinds of soft tissue injuries.