Podiatric Surgery
Joint Manipulation Under Anaesthetic Introduction
This leaflet will explain what will happen when you come to the hospital for a procedure to manipulate your foot joints under a local anaesthetic to try to help relieve your symptoms. Why do I need this procedure? Joints in the foot can sometimes become painful and stiff. This can be due to muscle spasm, misalignment of the joint, trapped tissue, or a tight joint capsule. Different types of arthritis and sports injuries can also cause joint pain and stiffness. A common treatment for joint pain is to manipulate the painful joint under local anaesthetic to help relieve muscle tension and improve the range of movement. The duration and level of benefit cannot be predicted.
What does the procedure involve? On the day of surgery you will be admitted to the ward and one of the nursing staff will check you in, take your blood pressure and perform any other tests that may be required. You should eat as normal as you do not have to starve for local anaesthetic. You will remain awake, but the area to be manipulated will be numbed. The surgeon will remind you of the procedure process and possible complications and ask you to sign a consent form. Your surgeon will numb your foot via a series of injections around the toe or ankle, or at the back of your leg above the knee. This is known as a popliteal block. If you have a popliteal block, your lower leg and foot will be numb and have no muscle power for up to 18 hours. This is used to relax any protective muscle spasm so pain is ‘switched off’, allowing the painful joint to be examined and moved through its range of motion.
Day vice
Your surgeon may inject a steroid into the joint. Steroid injections are used for a variety of foot problems. In some cases they cure the problem, and in other cases the steroid will help with your pain, but further treatment may be required.
How will I feel afterwards? Although long-acting local anaesthetic administered during the procedure should control most of the pain for about eight to 10 hours, you can expect some pain or discomfort after the operation. Painkillers will be discussed with you prior to your operation and you should bring these with you on the day of surgery. Recovering from the procedure Following this day-case procedure, you are advised not to bear weight through the foot and stay at home for the first 24 hours after the anaesthetic. Due to the effects of the anaesthetic, you should not drive for 24 hours. If you have had a popliteal block you will be given crutches to use until the anaesthetic wears off.
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Joint Manipulation Under Anaesthetic Some patients might experience an increase of pain after the procedure. This may start a few hours after the procedure and last for a few days. This increase in discomfort, should it occur, can be managed with ice packs and painkillers, such as paracetamol and/or ibuprofen. When you attend for your procedure, please ensure you have someone to take you home (avoid public transport) and do not drive. Elevate the foot for 24 hours after the injection.
What are the possible risks and complications? A successful outcome for all procedures cannot be guaranteed. Complications of this procedure include stiffness, swelling, and infection. The duration and level of benefit cannot be predicted. Specific complications of joint manipulation under anaesthetic Like any medical treatment, there are possible risks and complications. Few patients get side effects and like any list, this is intended as a guide only. Steroid flare. This is an acute inflammatory reaction, probably caused by the crystal structure of the steroid solution. The area becomes acutely painful, red, hot and swollen but remains localised. In the rare event of this happening, please apply an ice pack, take painkillers and if necessary, call the day surgery unit. It usually subsides within 24 hours. Soft tissue damage can occur but this is usually localised. Thinning of fat after steroid injection is a major and very rare complication. Steroid can depigment (lighten) the skin around the injection site and this would be more noticeable on black skin. This change could be permanent. Infection is possible after any injection.
Useful numbers Braintree Community Hospital
Podiatric Day Surgery Unit
01376 555 900
Day vice
01376 555 908
If you have any concerns during the first 24 hours following your discharge from hospital, please telephone the ward you were on. After 24 hours, please seek advice from your GP. This document can be made available in other languages and formats upon request. Podiatric Surgery at Braintree Community Hospital, April 2015. Review due: July 2019
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