Peripheral Arterial Disease

Ankle osteoarthritis is a condition that causes pain and stiffness in the ankle joint. Traditional treatments like joint fusion can limit mobility. An alternative procedure called ankle distraction arthroplasty has been gaining some traction, but how well does it hold up in the long term? 

A recent study by Greenfield et al. (2019) investigated this very question. They conducted a survival analysis of ankle distraction arthroplasty for ankle osteoarthritis. Their findings suggest that this procedure may be a viable option for some patients. 

Key takeaways from the study: 

  • Ankle distraction arthroplasty showed promising results, with an 84% survival rate at 5 years. This is better than some previously reported outcomes. 
  • The study also identified factors that can influence the success of the procedure. Avascular necrosis of the talus (bone death) was associated with a lower survival rate. Additionally, sex may play a role, with the study suggesting potential gender differences in long-term outcomes. 

What this means for patients: 

Ankle distraction arthroplasty offers a potential option for preserving joint mobility in patients with ankle osteoarthritis. This study provides valuable data for surgeons and patients to consider when making treatment decisions. 

Important to note: 

  • This was a retrospective study, meaning researchers analyzed past data. More robust research designs are needed to confirm these findings. 
  • The study involved a relatively small group of patients. Larger studies are necessary to draw more definitive conclusions. 

Overall, this research suggests that ankle distraction arthroplasty may be a valuable tool for treating ankle osteoarthritis. However, more research is needed to solidify its place as a standard treatment option. 

ReferenceGreenfield, S., Matta, K. M., McCoy, T. H., Rozbruch, S. R., & Fragomen, A. (2019). Ankle distraction arthroplasty for ankle osteoarthritis: a survival analysis. Strategies in trauma and limb reconstruction, 14(2), 65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376580/#:~:text=In%20a%20significantly%20larger%20series,and%2037%25%20within%205%20years

Disclaimer:

This blog is for informational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional to discuss your individual treatment options.
 

Image Credit: National Heart, Lung and Blood Institute

“Our greatest happiness does not depend on the condition of life in which chance has placed us, but is always the result of a good conscience, good health, occupation, and freedom in all just pursuits.”- Thomas Jefferson

Article Authors: Gordon Slater| Tandose Sambo 

What Is Peripheral Arterial Disease? 

The health of our circulatory system is one of the key contributors to our health. Peripheral artery disease (P.A.D.), is a disease that results from an accumulation of plaque in the arteries that carry blood to various parts of the bodies such as the head, organs and extremities. The plaque that accumulates in the arteries is as a result of accumulation of various substances in the blood including fat, cholesterol and calcium. 

With an accumulation of plaque in the arteries, they will eventually harden and narrow. A restriction in the arteries, results in a limited flow of oxygen rich blood to critical portions of the body. These include various organs, the heart, the stomach, arms and legs. The legs however, are the areas that are predominantly affected by Peripheral Artery Disease. With a lack of oxygen rich blood to the legs, there is often pain called claudication that is experienced by patients. PAD in the body is an indication of downstream ailments, if it is left untreated. Patients who do not monitor their condition are at risk of strokes and heart attacks due to the impacts of PAD on the circulatory system which feeds the brain and the heart. 

The blocked blood flow to the legs can often cause pain and numbness. The pain is often experienced during instances of activity. Many persons with PAD do not have the ability to walk for very long distances without having to stop due to painful legs. Gangrene, or tissue death are additional effects that patients experience with PAD. 

Physical activity such as walking or climbing stairs, causes leg pain in PAD patients. If you’re experiencing these symptoms with shortness of breath, take the time to have a physical examination of your body, conducted by a specialist. If necessary, you will be referred to a cardiovascular specialist, who will be able to determine the root cause of your condition. 

The link between Smoking and PAD 

Scientific studies have indicated a direct correlation between smoking and PAD. The risk of PAD increases with the habit of smoking. The first step to curing the condition is to ensure that you stop smoking. As a treatable condition, PAD is  a condition that can be managed. With treatment, the risk of complications will be reduced significantly. Via a series of changes in lifestyle, incorporated with the appropriate prescribed medicines and surgical procedures PAD will be easily managed. 

Signs & Symptoms

Most people have no symptoms during the early stages of PAD. Often, by the time symptoms are noticed, the arteries are already significantly blocked.

Common symptoms of PAD include:

  • Leg pain (cramping) that occurs while walking (intermittent claudication)
  • Leg pain (cramping) that occurs while lying down (rest pain)
  • Leg numbness or weakness
  • Cold legs or feet
  • Sores that will not heal on toes, feet or legs
  • A change in leg color
  • Loss of hair on the feet and legs
  • Changes in toenail color and thickness
     

If any of these symptoms are present, it is important to discuss them with a foot and ankle surgeon. Left untreated, PAD can lead to debilitating and limb-threatening consequences.

Source: [1]

PAD Risk Factors

Because only half of those with PAD actually experience symptoms, it is important that people with known risk factors be screened or tested for PAD.

The risk factors include:

  • Being over age 50
  • Smoking (currently or previously)
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Personal or family history of PAD, heart disease, heart attack or stroke
  • Sedentary lifestyle (infrequent or no exercise)

Source:[1]
 

How Is PAD diagnosed?

There are a series of activities that your Orthopaedic surgeon will incorporate into your PAD diagnosis. This involves an initial comprehensive medical history analysis. Physical examination in the lower extremity will analyse the pulse rate, skin health and foot condition. Based on the appropriate decision matrix, if risk factors for PAD are indicated from the initial examination, the concluding tests will then be performed. These tests include the ankle-brachial index (ABI) test, which compares ankle and arm blood pressures for any distinct differentials. Vascular specialists are incorporated where necessary. 

How Is PAD Treated? 

The treatment of PAD involves a variety of lifestyle changes, the utilisation of medication and where necessary the incorporation of surgery to clear the vascular system of blockages. Smoking cessation, the inclusion of exercise and a balanced diet are key to improving your health. Medications that will improve circulation are often administered. These medications will regulate the internal body chemistry in order to control blood pressure, cholesterol and blood glucose levels. Surgical procedures such as endovascular procedures and leg bypass surgeries are often incorporated into the treatment plan. 

The key to good PAD management involves ensuring that the entire system of treatments is optimised according to the patients needs. With all of these changes implemented, the risk of heart attack and stroke and claudication will be reduced. Via an appropriate feedback loop, the patient will have an improvement in their mobility and quality of life. With each set of physical examinations, and the existing signs and symptoms, the various risk factors will be controlled. 

Surgical Treatments of Peripheral Artery Disease

Bypass Grafting

PAD creates restrictions in the blood flow through the circulatory system. Bypass grafting surgery is a procedure that is usually conducted by the orthopaedic surgeon in order to restore blood flow to limbs. Utilising a blood vessel from another part of the body or a synthetic vessel, a graft will be created. The bypass graft is used to create a bridged flow of blood that goes around the blocked artery. It is a countermeasure that will increase blood flow to an affected limb. The root cause of PAD will have to be addressed by lifestyle changes. 

Angioplasty and Stent Placement

An angioplasty is a procedure that restores blood flow through a narrowed or blocked artery. Catheters are utilised during this procedure in order to expand the artery. The catheter is a thin inflatable tube that will displace the plaque towards the outer edges of the artery wall. Once the restriction is eliminated, the blood flow to the area is restored. The catheter is removed after the angioplasty. In order to sustain the widened artery, a stent is placed to reinforce the procedure. Medicinal coatings on the stent, help to treat and prevent blockages.

Atherectomy

Another treatment that can improve PAD is the removal of the actual plaque from the artery. Utilising a catheter, a small cutting device is installed into the blocked artery. The plaque is then shaved away. Laser treatment of plaque is also an option. 

PAD & Orthopaedic conditions

As a condition that affects the extremities, there is a noticeable increase in foot deformities with PAD. Cases of hammertoes, bunions, bony prominences and dermatologic conditions are often increased in patients with PAD. With limited blood flow to the legs and feet, the presence of cuts, blisters and sores must be treated with extreme care. Neuropathy is also a condition that results in PAD patients and causes ulcers. If care is not taken, the patient’s leg can ultimately be amputated. For this reason, preventative care will be important to sustain the health of the patient. 

Avoiding PAD Complications

There are a few things that you can do to ensure that you are keeping your PAD under control. With diet and exercise, and regular foot examinations, you will be able to stay in good health. Wash your feet daily, and dry them well. The application of lotions will keep the skin nice and soft. Patients with PAD should not go barefoot, even indoors, in order to keep their feet protected. Prevention is better than cure. 

Reference: 

[1] FootHealthFacts: https://www.foothealthfacts.org/conditions/peripheral-arterial-disease-(p-a-d-)

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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