OKOJ, Volume 12, No. 11

End-stage arthritis of the ankle is a chronic and disabling condition that often requires surgical intervention. Arthrodesis of the ankle has long been the preferred surgical treatment for the most severe forms of this condition. Although ankle arthrodesis is an excellent procedure for eliminating pain, it can be accomplished through many different techniques, all of which have associated limitations, including wound-related complications, nonunion, malunion, and the potentially premature degeneration of joints adjacent to the ankle. To limit the risk of these problems, various attempts have been made to develop improved techniques and protocols for arthrodesis of the ankle. This article reviews the most popular techniques currently in use for ankle arthrodesis, alternatives to these techniques, and the role of these alternatives in different clinical settings, including their strengths and shortcomings in various settings. The review is limited to tibiotalar arthrodesis and does not cover tibiotalocalcaneal arthrodesis, which is done through its own set of techniques and fixation methods.

Tarsal tunnel syndrome refers to neuralgia of the tibial nerve or any of its terminal branches within the tarsal tunnel of the ankle. Often, this syndrome refers to a compression or entrapment neuropathy, but it may also be secondary to a neurapraxia. Tarsal tunnel syndrome may be caused by space-occupying lesions, trauma, deformity, and malalignment of the lower extremity. However, a specific cause for tarsal tunnel syndrome is found in only 60% to 80% of patients. Treatment of tarsal tunnel syndrome is patient-specific, depending on the underlying etiology. Nonsurgical management includes the use of anti-inflammatory medications and other medications used for neuralgia. Braces, including foot orthoses, stirrup braces, prefabricated ankle-foot orthoses, and boot braces, can be effective as a mechanical first-line treatment. When nonsurgical options fail to relieve symptoms, or when there is a specific surgical indication, surgical procedures, including nerve decompression and release, surgical excision of a compressive lesion, and deformity correction, may be useful. This article highlights the diagnosis and work-up of patients with tarsal tunnel syndrome, and describes the technique for decompression of the tarsal tunnel through release of the tibial nerve and its associated branches.

Acute proximal hamstring rupture is an increasingly recognized clinical entity in the physically active population. Its nonsurgical treatment may result in several complications, including muscle weakness and sciatic neuralgia. In this article, we present a technique for the repair of injury to the proximal hamstring tendons through a 4- to 5-cm incision across the gluteal crease. This provides both adequate accessibility to the ruptured hamstring tendons and good cosmesis after healing. The tendons are repaired to bone with the use of two to four double-loaded suture anchors. For initial postoperative management, the affected leg is placed in a hinged brace with limited weight bearing. The purpose of this article is to provide surgeons with a safe, reliable method for the repair of an acute complete rupture of the proximal hamstring tendons and postoperative rehabilitation of the patient.