{"id":9500,"date":"2024-05-02T11:15:55","date_gmt":"2024-05-02T11:15:55","guid":{"rendered":"https:\/\/paleyinstitute.org\/?page_id=9500"},"modified":"2025-06-16T18:31:33","modified_gmt":"2025-06-16T18:31:33","slug":"ankle-preservation","status":"publish","type":"page","link":"https:\/\/paleyinstitute.org\/ankle-preservation\/","title":{"rendered":"Ankle Preservation"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"9500\" class=\"elementor elementor-9500\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-565d278 elementor-section-full_width elementor-section-height-min-height elementor-section-height-default elementor-section-items-middle wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"565d278\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4914aa6\" data-id=\"4914aa6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-466876b elementor-widget elementor-widget-heading\" data-id=\"466876b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Ankle Preservation<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7141102 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"7141102\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-56f4fb0\" data-id=\"56f4fb0\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a7066f4 elementor-widget elementor-widget-heading\" data-id=\"a7066f4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Paley Institute Joint Preservation & Replacement Center<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5a023b7 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"5a023b7\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-28125e1\" data-id=\"28125e1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ff3fa55 elementor-widget__width-inherit elementor-widget-mobile__width-inherit elementor-widget-tablet__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"ff3fa55\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Osteoarthritis of the ankle, caused by wear and tear of the joint, results in swelling, pain, and foot deformity. Recommended treatment options include total joint replacement and arthrodesis. At the Paley Institute, we offer an alternative: joint preservation techniques that retain the patient\u2019s natural ankle joint and ankle motion.<\/p><p>We use a technique that involves distraction of the joint with external fixation. This procedure is a viable alternative to arthrodesis and \/ or joint replacement, with the added benefit of restoring normal joint anatomy. The technique uses the principle of ligamentotaxis to restore normal joint space, improving joint loading, and providing an environment in which the joint cartilage can recover.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6890650 elementor-widget elementor-widget-text-editor\" data-id=\"6890650\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><b>Indications for ankle joint distraction include.<\/b><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0ef8268 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"0ef8268\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-d0c5b1d\" data-id=\"d0c5b1d\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c4592d6 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"c4592d6\" data-element_type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img decoding=\"async\" width=\"100\" height=\"100\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/joint-surface-1.png\" class=\"attachment-full size-full wp-image-9536\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Congruent joint surface<\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-6dfae6d\" data-id=\"6dfae6d\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-307e813 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"307e813\" data-element_type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img decoding=\"async\" width=\"128\" height=\"128\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/clubfoot.png\" class=\"attachment-full size-full wp-image-9537\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Ankle pain<\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-4c44867\" data-id=\"4c44867\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0d81520 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"0d81520\" data-element_type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img decoding=\"async\" width=\"100\" height=\"100\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/ankle-mobility.png\" class=\"attachment-full size-full wp-image-9538\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Reduced ankle mobility<\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-129f6dd\" data-id=\"129f6dd\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ff09e63 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"ff09e63\" data-element_type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"100\" height=\"100\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/osteoarthritis.png\" class=\"attachment-full size-full wp-image-9539\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Moderate to severe osteoarthritis<\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ee0fb48 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"ee0fb48\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9a45bd0\" data-id=\"9a45bd0\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-103d64c elementor-widget__width-inherit elementor-widget-mobile__width-inherit elementor-widget-tablet__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"103d64c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"text-mb\">Joint distraction may also be efficacious in treating avascular necrosis of the talus.<\/p><p class=\"text-mb\">Ankle distraction works by transferring the weight-bearing forces from the cartilage to the external fixator. This relieves pressure on the cartilage, allowing it heal. Weight bearing in the fixator also allows for continued intra-articular fluid pressure and increased synovial fluid, providing further cartilage restoration. Fixation also allows for reduction in the subchondral bone density, increasing the resiliency of the joint. These changes allow the osteoarthritic cartilage to regenerate.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-929a678 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"929a678\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fdbeca5\" data-id=\"fdbeca5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c93b314 elementor-widget elementor-widget-heading\" data-id=\"c93b314\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Our Method<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c61003e elementor-widget__width-inherit elementor-widget-mobile__width-inherit elementor-widget-tablet__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"c61003e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Drs. Paley and Lamm developed multiple improvements upon the initially published techniques for ankle distraction. First, they built an ankle distractor with a hinge that allows patients to perform range-of-motion exercises throughout the distraction treatment. Second, they included additional surgical procedures to increase range of motion, eliminate impingement, improve stability, and improve joint orientation. The modifications are as follows:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2581305 elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"2581305\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Hinged ankle joint distraction<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-30b3a76 elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"30b3a76\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Allows joint range-of-motion exercises during treatment<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e9e0bc9 elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"e9e0bc9\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Correction of osseous alignment during osteotomy<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-56c7bf7 elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"56c7bf7\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Soft tissue releases<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5a617b3 elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"5a617b3\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Corrects soft tissue contractures<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a8f425f elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"a8f425f\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Resection of osteophytes and osteochondroplasty<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7d05ae6 elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"7d05ae6\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Treats joint impingement<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4efc2a8 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"4efc2a8\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ed794ad\" data-id=\"ed794ad\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8de9be5 elementor-widget elementor-widget-heading\" data-id=\"8de9be5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Surgical Procedure<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4f3a13a elementor-widget elementor-widget-heading\" data-id=\"4f3a13a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Blocking Osteophyte Resection<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4f31985 elementor-widget elementor-widget-text-editor\" data-id=\"4f31985\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>If dorsiflexion (pulling the foot upward) is limited by osteophytes (bony outgrowths that develop when cartilage deteriorates), we will resect the osteophytes through an anterior (front of the foot) incision. If plantar flexion (pushing the foot downward) is limited by osteophytes, they are removed via a posterolateral (to the side and to the back) incision. To prevent osteophytic recurrence, bone wax is applied to the bone. Nonsteroidal anti-inflammatory drugs (NSAIDs) are administered postoperatively for 6 weeks to inhibit bone formation. However, NSAIDs are not administered if an osteotomy is performed during surgery.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0166af2 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"0166af2\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5c8ae01\" data-id=\"5c8ae01\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fdfeae7 elementor-widget elementor-widget-heading\" data-id=\"fdfeae7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Equinus Contracture Release<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-28ef9c9 elementor-widget elementor-widget-text-editor\" data-id=\"28ef9c9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Equinus contracture is released by performing a gastrocnemius recession, a gastrocnemius-soleus recession, or an Achilles tendon lengthening. We prefer gastrocnemius recession or gastrocnemius-soleus recession, in order to maintain muscle strength. A posterior capsule release may be necessary to restore ankle joint range of motion. A tarsal tunnel decompression is often necessary to prevent nerve entrapment. When acute release does not reduce the equinus, it can be corrected gradually via distraction.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a1fbd45 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"a1fbd45\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fcc83ad\" data-id=\"fcc83ad\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0437d0b elementor-widget elementor-widget-heading\" data-id=\"0437d0b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Ankle Joint Realignment<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cb37be6 elementor-widget elementor-widget-text-editor\" data-id=\"cb37be6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Ankle joint malalignment due to deformities such as valgus and recurvatum may be the underlying cause of the ankle joint degeneration. To preserve the ankle joint, we will perform reorientation procedures, including osteotomy (surgical bone cut). Correction is usually done using a supramalleolar osteotomy. If there is incongruence between the tibia and fibula, then the tibia can be lengthened or the fibula shortened to restore normal ankle anatomy. We will address any subtalar joint contractures at the time of realignment and distraction. This can be done acutely via release or gradually via the external fixator.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ba2a60c elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"ba2a60c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a03417e\" data-id=\"a03417e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-717194d elementor-widget elementor-widget-heading\" data-id=\"717194d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Application of Hinged External Fixator<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-74e2a54 elementor-widget elementor-widget-text-editor\" data-id=\"74e2a54\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The hinged external fixator is applied to the foot and tibia. We prefer to simultaneously distract both the subtalar and ankle joints acutely. This is done by applying distraction between the tibial and foot fixation before inserting wires into the talus.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5c8a69c elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"5c8a69c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-ac9a649\" data-id=\"ac9a649\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8188802 glow-line elementor-widget-tablet__width-initial elementor-widget elementor-widget-image\" data-id=\"8188802\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"356\" height=\"610\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation1.png\" class=\"attachment-large size-large wp-image-9576\" alt=\"\" srcset=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation1.png 356w, https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation1-175x300.png 175w\" sizes=\"(max-width: 356px) 100vw, 356px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6e5d934 elementor-widget elementor-widget-text-editor\" data-id=\"6e5d934\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Two-ring fixation is placed on the tibia using a wire and three half-pins. A center of rotation wire is placed through the Inman axis of the ankle (dotted line). This is used for positioning the ankle hinge.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-3800bca\" data-id=\"3800bca\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8907501 glow-line elementor-widget elementor-widget-image\" data-id=\"8907501\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"356\" height=\"610\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation2.png\" class=\"attachment-large size-large wp-image-9577\" alt=\"\" srcset=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation2.png 356w, https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation2-175x300.png 175w\" sizes=\"(max-width: 356px) 100vw, 356px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a3d0b21 elementor-widget elementor-widget-text-editor\" data-id=\"a3d0b21\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The foot ring is mounted parallel to the sole of the foot. The foot ring is closed by attaching a half ring to the distal end of the U-shaped foot ring. Fixation of the foot ring is achieved with two crossed wires in the calcaneus, two talar neck wires, and one wire across the midfoot. Hinges are placed at the Inman axis.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-2e5e904\" data-id=\"2e5e904\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e939ad1 glow-line elementor-widget elementor-widget-image\" data-id=\"e939ad1\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"428\" height=\"420\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation3.png\" class=\"attachment-large size-large wp-image-9578\" alt=\"\" srcset=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation3.png 428w, https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/anklepreservation3-300x294.png 300w\" sizes=\"(max-width: 428px) 100vw, 428px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2806812 elementor-widget elementor-widget-text-editor\" data-id=\"2806812\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Posterior distraction rod is placed and can be removed for the patient for ankle range-of-motion exercises<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c05b741 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"c05b741\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a4cde2c\" data-id=\"a4cde2c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f134eba elementor-widget elementor-widget-text-editor\" data-id=\"f134eba\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The patient starts distraction at a rate of 1 mm per day on postoperative day 1 for a total of 5 days. The goal is to achieve 8-10 mm of distraction. The external fixator is then maintained for 3 months while allowing weight bearing as tolerated. The patient performs daily ankle range of motion exercises and should attend physical therapy three times a week.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5b34fc9 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"5b34fc9\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f8f04c8\" data-id=\"f8f04c8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7430e9a elementor-widget elementor-widget-heading\" data-id=\"7430e9a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Summary<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-76a211f elementor-widget elementor-widget-text-editor\" data-id=\"76a211f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"text-mb\">In a published study, Dr. Paley and Dr. Lamm reported their results on 32 patients who underwent ankle joint distraction and found 78% had maintained their ankle range of motion and had none to occasional pain that could be managed with NSAIDs. Only one patient required an ankle fusion and only one was converted to an ankle joint replacement. These results suggest that Dr. Paley&#8217;s and Dr. Lamm&#8217;s approach improves upon the results of this procedure.<\/p><p class=\"text-mb\">Ankle joint distraction is a strong viable alternative to ankle arthrodesis or ankle replacement. A congruent, painful, mobile, and arthritic ankle joint treated with this technique can achieve good results. The \u00e0 la carte approach developed by Drs. Paley and Lamm results in more successful outcomes using this approach.<\/p><p class=\"text-mb\">For more information, see\u00a0<span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"http:\/\/paleyinstitute.org\/wp-content\/uploads\/AnkleHipDistractionProofs.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #0057a6;\">Joint Distraction for Special Conditions<\/span><\/a><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-24a3194 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"24a3194\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5129aac\" data-id=\"5129aac\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7e97c21 elementor-widget elementor-widget-heading\" data-id=\"7e97c21\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Doctors who specialize in Ankle Preservation in West Palm Beach<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5116718 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"5116718\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-441759f\" data-id=\"441759f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ab669ce elementor-widget-tablet__width-initial elementor-widget-mobile__width-inherit elementor-cta--skin-classic elementor-animated-content elementor-bg-transform elementor-bg-transform-zoom-in elementor-widget elementor-widget-call-to-action\" data-id=\"ab669ce\" data-element_type=\"widget\" data-widget_type=\"call-to-action.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<a class=\"elementor-cta\" href=\"https:\/\/paleyinstitute.org\/dr-bradley-lamm\/\">\n\t\t\t\t\t<div class=\"elementor-cta__bg-wrapper\">\n\t\t\t\t<div class=\"elementor-cta__bg elementor-bg\" style=\"background-image: url(https:\/\/paleyinstitute.org\/wp-content\/uploads\/2025\/03\/Dr-Lamm.jpg);\" role=\"img\" aria-label=\"Dr. Bradley Lamm\"><\/div>\n\t\t\t\t<div class=\"elementor-cta__bg-overlay\"><\/div>\n\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-cta__content\">\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<h1 class=\"elementor-cta__title elementor-cta__content-item elementor-content-item\">\n\t\t\t\t\t\tDr. Bradley Lamm\t\t\t\t\t<\/h1>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-cta__description elementor-cta__content-item elementor-content-item\">\n\t\t\t\t\t\tFoot & Ankle Director\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-cta__button-wrapper elementor-cta__content-item elementor-content-item \">\n\t\t\t\t\t<span class=\"elementor-cta__button elementor-button elementor-size-\">\n\t\t\t\t\t\tSchedule an Appointment\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-d394b1f elementor-hidden-mobile\" data-id=\"d394b1f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-dc2f12c elementor-hidden-mobile\" data-id=\"dc2f12c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-750670f elementor-hidden-mobile elementor-hidden-tablet\" data-id=\"750670f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Ankle Preservation Paley Institute Joint Preservation &#038; Replacement Center Osteoarthritis of the ankle, caused by wear and tear of the joint, results in swelling, pain, and foot deformity. Recommended treatment options include total joint replacement and arthrodesis. At the Paley Institute, we offer an alternative: joint preservation techniques that retain the patient\u2019s natural ankle joint and ankle motion. We use a technique that involves distraction of the joint with external fixation. This procedure is a viable alternative to arthrodesis and \/ or joint replacement, with the added benefit of restoring normal joint anatomy. The technique uses the principle of ligamentotaxis to restore normal joint space, improving joint loading, and providing an environment in which the joint cartilage can recover. Indications for ankle joint distraction include. Congruent joint surface Ankle pain Reduced ankle mobility Moderate to severe osteoarthritis Joint distraction may also be efficacious in treating avascular necrosis of the talus. Ankle distraction works by transferring the weight-bearing forces from the cartilage to the external fixator. This relieves pressure on the cartilage, allowing it heal. Weight bearing in the fixator also allows for continued intra-articular fluid pressure and increased synovial fluid, providing further cartilage restoration. Fixation also allows for reduction in the subchondral bone density, increasing the resiliency of the joint. These changes allow the osteoarthritic cartilage to regenerate. Our Method Drs. Paley and Lamm developed multiple improvements upon the initially published techniques for ankle distraction. First, they built an ankle distractor with a hinge that allows patients to perform range-of-motion exercises throughout the distraction treatment. Second, they included additional surgical procedures to increase range of motion, eliminate impingement, improve stability, and improve joint orientation. The modifications are as follows: Hinged ankle joint distraction Allows joint range-of-motion exercises during treatment Correction of osseous alignment during osteotomy Soft tissue releases Corrects soft tissue contractures Resection of osteophytes and osteochondroplasty Treats joint impingement Surgical Procedure Blocking Osteophyte Resection If dorsiflexion (pulling the foot upward) is limited by osteophytes (bony outgrowths that develop when cartilage deteriorates), we will resect the osteophytes through an anterior (front of the foot) incision. If plantar flexion (pushing the foot downward) is limited by osteophytes, they are removed via a posterolateral (to the side and to the back) incision. To prevent osteophytic recurrence, bone wax is applied to the bone. Nonsteroidal anti-inflammatory drugs (NSAIDs) are administered postoperatively for 6 weeks to inhibit bone formation. However, NSAIDs are not administered if an osteotomy is performed during surgery. Equinus Contracture Release Equinus contracture is released by performing a gastrocnemius recession, a gastrocnemius-soleus recession, or an Achilles tendon lengthening. We prefer gastrocnemius recession or gastrocnemius-soleus recession, in order to maintain muscle strength. A posterior capsule release may be necessary to restore ankle joint range of motion. A tarsal tunnel decompression is often necessary to prevent nerve entrapment. When acute release does not reduce the equinus, it can be corrected gradually via distraction. Ankle Joint Realignment Ankle joint malalignment due to deformities such as valgus and recurvatum may be the underlying cause of the ankle joint degeneration. To preserve the ankle joint, we will perform reorientation procedures, including osteotomy (surgical bone cut). Correction is usually done using a supramalleolar osteotomy. If there is incongruence between the tibia and fibula, then the tibia can be lengthened or the fibula shortened to restore normal ankle anatomy. We will address any subtalar joint contractures at the time of realignment and distraction. This can be done acutely via release or gradually via the external fixator. Application of Hinged External Fixator The hinged external fixator is applied to the foot and tibia. We prefer to simultaneously distract both the subtalar and ankle joints acutely. This is done by applying distraction between the tibial and foot fixation before inserting wires into the talus. Two-ring fixation is placed on the tibia using a wire and three half-pins. A center of rotation wire is placed through the Inman axis of the ankle (dotted line). This is used for positioning the ankle hinge. The foot ring is mounted parallel to the sole of the foot. The foot ring is closed by attaching a half ring to the distal end of the U-shaped foot ring. Fixation of the foot ring is achieved with two crossed wires in the calcaneus, two talar neck wires, and one wire across the midfoot. Hinges are placed at the Inman axis. Posterior distraction rod is placed and can be removed for the patient for ankle range-of-motion exercises The patient starts distraction at a rate of 1 mm per day on postoperative day 1 for a total of 5 days. The goal is to achieve 8-10 mm of distraction. The external fixator is then maintained for 3 months while allowing weight bearing as tolerated. The patient performs daily ankle range of motion exercises and should attend physical therapy three times a week. Summary In a published study, Dr. Paley and Dr. Lamm reported their results on 32 patients who underwent ankle joint distraction and found 78% had maintained their ankle range of motion and had none to occasional pain that could be managed with NSAIDs. Only one patient required an ankle fusion and only one was converted to an ankle joint replacement. These results suggest that Dr. Paley&#8217;s and Dr. Lamm&#8217;s approach improves upon the results of this procedure. Ankle joint distraction is a strong viable alternative to ankle arthrodesis or ankle replacement. A congruent, painful, mobile, and arthritic ankle joint treated with this technique can achieve good results. The \u00e0 la carte approach developed by Drs. Paley and Lamm results in more successful outcomes using this approach. For more information, see\u00a0Joint Distraction for Special Conditions Doctors who specialize in Ankle Preservation in West Palm Beach Dr. Bradley Lamm Foot &#038; Ankle Director Schedule an Appointment<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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