01 Nov 2010
Walk without pain
Tendon endoscopy, a minimally invasive procedure, allows for surgery around the ankle with less risk of wound complications
Mr Joseph Lazar suffered from pain in his right ankle for over a year, and a fall left him unable to walk and his foot in a cast for six weeks. Even three strong injections couldn’t numb the pain.
But his doctor was reluctant to consider surgery to correct his condition, known as Achilles tendonitis, because the 60-year-old had other medical problems that can lead to serious complications.
“Because of my diabetes, it’s dangerous for me to have open wounds or cuts. They may not heal, and I can suffer from massive blood loss,” said Mr Lazar.
Achilles tendonitis is an inflammation of the Achilles tendon, the thickest and strongest in the body that lies behind the ankle and connects the calf muscle to the heel bone. In Achilles tendonitis, numerous microscopic tears in the tendon occur, a result of overuse or stress from physical exertion.
The lining of the tendon, called the paratenon, can become thickened and its ability to glide can become limited, causing friction and pain.
Conventional surgery involves a huge cut because “the tendon is a very long structure”, said Dr Chong Keen Wai, Consultant, Department of Orthopaedic Surgery, Singapore General Hospital.
Dr Chong, who specialises in treating ankle injuries using a new procedure known as minimally invasive endoscopic tendon surgery or tendon endoscopy, was asked to consider Mr Lazar for the surgery. In such procedures, two small puncture wounds are made in the ankle area, which lowers the risk of infection or blood loss considerably.
More importantly, an endoscope – a tube with a light and camera – that is inserted through the holes is able to accurately examine and treat the injuries. Advances in fibre optic technology have led to the production of more intricate endoscopes. These tiny instruments can enter and treat areas of the body that are packed with muscle, tendons and nerves such as the ankle, Dr Chong said.
“Endoscopes are now used to treat tendon problems in the ankle because it allows us to repair the tendons without resorting to open surgery,” he said.
“Mr Lazar was able to undergo the surgery and heal quickly without evoking other health risks,” he added.
Mr Lazar started walking about a week after surgery. “I was supposed to use support to help me walk, but I didn’t even need it because my ankle healed so quickly,” Mr Lazar said. Had Mr Lazar undergone conventional surgery, his ankle would have been put in a cast for some time.
He would also have been at risk of wound infection and wound breakdown – an inability or difficulty of the wound to heal – as the skin around the ankle is thin and he has diabetes. During his surgery, which lasted just half an hour, his diseased tendon was freed of all scar tissue and the degenerative parts were removed.
It’s been a year since, and Mr Lazar has not had a recurrence of ankle pain.
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Dept of Orthopaedic Surgery
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