Repair of Nerve and Tendon Injuries
The foot and ankle are supplied by many nerves and supported by tendons. Injuries to these structures are usually caused by penetrating wounds, which can lead to various problems and abnormalities.
Nerve injuries can lead to the lack of sensation in the foot and cause nerve cells to regenerate into the surrounding tissue to form a painful growth called neuroma. Injury to the motor nerves can lead to clawing of the toes due to imbalance of muscular forces.
Nerve repair includes preparation of the injured nerve stumps and joining of the nerve ends without tension. If repair can cause tension in the nerve, a nerve section from another part of the body is removed and used as a graft to join the two ends. It is usually performed as a microscopic surgery.
A neuroma can be prevented by timely nerve repair and nerve grafting procedures. Once neuroma has formed, it may be treated conservatively with medicines, steroid injections, nerve stimulation or mechanical desensitization. Surgical treatment may include excision of the neuroma and embedding the nerve stump in a non-irritable region. Following repair, three weeks of immobilization is necessary to allow the repaired nerves to heal completely.
Tendons of the foot attach muscles to bone and are responsible for important foot movements. Tendon injuries can lead to ankle instability and problems with walking.
It is necessary to identify and treat tendon injuries early for better relief. The wound site is cleaned off foreign bodies and dead tissue and tendon is repaired surgically with stitches. If the tendon is injured close to its attachment to bone, suture anchors may be placed in holes drilled in the bone to enable a stable fixation. Delay in treatment may lead to the retraction of muscle-tendon complex, producing a gap in the tendon and formation of scar tissue. It can then be corrected by tendon reconstruction, tendon transfer (replacing damaged tendon with graft) and osteotomy (removal of bone) procedures.
- Major and Minor fracture care
- Treatment of sprains and inversion injuries
- Treatment of osteochondritis dissecans of the ankle
- Post –traumatic reconstructions