Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Ankle

The ankle joint is a remarkable example of the functional interplay between bones, joints, and ligamentous structures, with their protective action upon one another. The ankle joint is maintained by the wedge-shaped talus and its sculptured fit between the tibia and fibula. In the neutral position of the ankle, there are strong osseous (bony) constraints. With increasing plantar flexion, the osseous constraints decrease and the soft

– apply ice massage in the acute phase (alternately with heat treatment);
– apply local heat and use a heat retainer after the acute phase;
– relieve pressure on the tendon by distributing the pressure of the shoe or skating boot over the surrounding parts of the foot, e.g. by putting foam rubber between the lacing and the tendon.
The doctor may:

– prescribe anti-inflammatory medication and ointments;
– prescribe an exercise program after the acute phase;
– apply a plaster cast or walking boot in severe cases when the injury is in its acute phase;
– operate in cases of complete rupture.

Ankle arthroscopy
Ankle arthroscopy is an increasingly useful technique for dealing with a wide range of ankle problems. It is used, not only for diagnosis but also as a valuable therapeutic tool. Indications include loose bodies, removal
of osteophytes, debridement of osteochondral defects of the talus, removal of chronic enlarged synovial tissue, lysis of adhesions, and meniscoid lesions.
Arthroscopy is carried out with the patient supine and often with spinal anesthesia.
This allows the patient to watch the television monitor, and the surgeon can explain the findings. A 4 mm, 30° arthroscope is used. If the joint is narrow, a smaller arthroscope is used. The anteromedial and anterolateral portals are routinely used. The anteromedial portal is first established
just above the tibiotalar joint. The skin incision is made just medial to the tibialis anterior tendon at the level of the tibiotalar joint. The wound is opened bluntly down to the capsule. The saphenous vein and accompanying nerve should be avoided. The anteromedial portal is more easily identified using
transillumination. Before the skin incision is made, the intermediate dorsal cutaneous branch of the superficial peroneal nerve is identified and the course of the nerve is marked with a pen. It is easier to palpate the nerve when the ankle is plantar flexed and in some inversion. Posterior portals such as the The foot receives and distributes the body load when walking, jumping and running. Most sports contain elements of running or jumping, during which the strains on the lower extremities of the body increase sharply.

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