Led by Dr. Timothy Daniels, head of Orthopedic Surgery and the first appointed foot and ankle chair, the team has established, in collaboration with Dr. Geoff Fernie of the Toronto Rehabilitation Institute, a Challenging Environment Assessment Lab – a one-of-a-kind, state-of-the-art laboratory to study the impact and effects of ankle arthritis on gait in various environmental settings and climate.
Presently, the team has one of the largest prospective registries on patients surgically managed for ankle arthritis. The registry includes preoperative and annual postoperative validated outcome questionnaires. The registry will answer many of the uncertainties and questions regarding ankle arthritis over the next decade.
With ankle replacement and ankle fusion procedures occurring on a regular basis at St. Michael’s Hospital, the registry continues to be updated constantly. This allows the team to gauge the effectiveness and lifespan of an ankle replacement, resulting in great advancements towards the treatment of ankle arthritis.
The Foot and Ankle team has one of the largest prospective registries on patients surgically managed for ankle arthritis which includes preoperative and annual postoperative validated outcome questionnaires. The registry will answer many of the uncertainties and questions regarding ankle arthritis over the next decade.
With ankle replacement surgeries – along with ankle fusions – occurring on a regular basis at St. Michael’s Hospital, the registry continues to be updated constantly. This allows the team to gauge the effectiveness and lifespan of an ankle replacement, resulting in great advancements towards the treatment of ankle arthritis.
With the rise of total ankle arthroplasty, the designs of ankle arthroplasty models and surgical methods have been constantly changing. This study is exploring the efficacy of the Scandinavian total ankle replacement and Hintegra prostheses through a retrospective comparative analysis using 100 patients.
To date, there has been a paucity of studies exploring the demographics, functional capacity, and health status of patients with ankle arthrosis (Buckwalter, 2004; Thomas, 2003; Agel, 2005). There is a complete void in the literature exploring these characteristics in patients with bilateral ankle arthrosis. The purpose of the study was to compare patients with end-stage unilateral ankle arthrosis awaiting surgical intervention to patients with bilateral ankle arthrosis in terms of loss of function, pain and health-related quality of life. In addition, the research team also examined the mid-term outcome of patients with bilateral arthritis who have undergone bilateral total ankle replacements to a cohort of patients with unilateral arthritis who have undergone unilateral total ankle replacement.
Postoperative analgesia with continuous peripheral nerve block after foot and ankle or shoulder surgery in ambulatory patients – A Phase 1 feasibility study, this research project is based on previous evidence that suggests continuous peripheral nerve block provided at home improves postoperative analgesia, sleep quality and patient satisfaction while decreasing supplemental opioid requirements and opioid-related side effects. It hypothesizes that a continuous peripheral nerve block as such will provide superior analgesia for foot and ankle and shoulder surgery in comparison to a single shot block and intravenous analgesics. Patients normally need to stay in the hospital overnight for such treatment, but the use of continuous peripheral nerve block can refute that requirement. Ten adult patients who underwent foot and ankle surgery and 10 adult patients who underwent shoulder surgery have been investigated, as per protocol.
This research aims to pose a set of radiographic “ankle-at-risk” signs to help predict which patients with adult-acquired flatfoot deformity will have poor outcomes with joint-sparing techniques and would thus need to be considered with joint-sacrificing techniques as a primary option. This project has led to the identification of 10 “ankle-at-risk” signs which can help predict which adult-acquired flatfoot deformity patients will have improved outcomes with joint-sacrificing rather than sparing treatment techniques – this was done through a retrospective review of preoperative X-rays belonging to a case series of patients who underwent flat foot reconstruction between 2004 and 2012. The findings were compared to postoperative correction rate and revision rate to identify any correlations.
This project is a prospective, randomized, controlled, non-inferiority clinical trial that is being conducted to evaluate the effect of weight-bearing as tolerated in comparison to non-weight bearing on patient outcomes following arthroscopic forage of osteochondral defects of the ankle. The main hypothesis posed was there will be no difference in subjective patient outcome scores between the immediate and delayed weight-bearing groups. A secondary hypothesis, judged via observation of healing on CT scans as a secondary measure, postulates that there will be no difference in objective radiologic findings of osteochondral healing between these two groups one year after surgery. This supports the desired concept of early mobilization and the return to function for patients who have undergone such procedures. This is significant with regards to the minimization of morbidity and costs associated with non-weight bearing cases, such as mobility aids, transportation and loss of income as a result of inability to function, and so on.
