JAMAL AL-ASIRI, MD FRCS(C)
Hamilton Orthopaedic Foot and Ankle Surgeon
Dr Jamal Al-Asiri is an orthopaedic surgeon in Hamilton, specialising in arthroscopic and reconstructive surgery of the foot and ankle.
He has particular interests in total ankle replacement, ligament reconstruction and forefoot reconstruction . He performs these surgeries at the Hamilton General Hospital and West Lincoln Hospitals in Hamilton.
Common Questions
Physiotherapy for Foot and Ankle Conditions
- Disclaimer: The following information is for educational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
General Physiotherapy for Foot and Ankle Health
- Physiotherapy plays a crucial role in recovering from a foot or ankle injury, managing chronic conditions, and preventing future problems. A tailored physiotherapy program can help you regain strength, flexibility, and balance, allowing you to return to your daily activities safely and efficiently.
- Key components of a general foot and ankle physiotherapy program include range of motion exercises to restore flexibility to the joints and soft tissues, strengthening exercises targeting the muscles of the lower leg, foot, and ankle to improve stability and support, and balance and proprioception training to improve your sense of joint position and stability, reducing the risk of re-injury.
- Additionally, gait analysis and training assess and correct your walking pattern to ensure proper mechanics and reduce stress on the joints, while manual therapy provides hands-on techniques such as massage and joint mobilization to reduce pain and improve mobility.
Physiotherapy for Common Foot and Ankle Conditions
- Post-Ankle Sprain Recovery focuses on reducing pain and swelling, restoring range of motion, and rebuilding strength and stability through a progressive program that begins with the RICE protocol (Rest, Ice, Compression, Elevation) and advances to sport-specific training and agility exercises.
- Achilles Tendinopathy Management aims to reduce pain and inflammation while improving tendon health through load management, eccentric strengthening exercises, gentle stretching of the calf muscles, and manual therapy techniques including soft tissue massage and ankle joint mobilization.
- Plantar Fasciitis Treatment addresses this common cause of heel pain through specific stretches for the plantar fascia and calf muscles, strengthening exercises for the intrinsic muscles of the foot, manual therapy for soft tissue release, supportive taping techniques, and recommendations for appropriate footwear and orthotics to support the arch of the foot.
Post-Operative Care Guidelines for Foot and Ankle Surgery -Post-Ankle Replacement Surgery
- Recovery after total ankle replacement is crucial for a successful outcome and follows a structured timeline. Immediately after surgery, patients wake up with their ankle in a cast or bulky dressing and must keep their leg elevated as much as possible to reduce swelling.
- During the first 2-4 weeks, patients remain non-weight-bearing, using crutches or a walker while keeping the foot elevated above heart level.
- The 4-8 week period involves transitioning to a walking boot and beginning partial weight-bearing as tolerated, along with starting formal physiotherapy to work on range of motion and gentle strengthening.
- At 8-12 weeks, patients may transition to regular footwear with possible supportive bracing while continuing physiotherapy to improve strength, balance, and gait.
- 3-6 months post-surgery brings significant improvement in walking ability and daily activities, with continued strengthening and functional exercises.
- Finally, 6-12 months represents full recovery with return to most previous activities, though some restrictions on high-impact sports may remain.
Post-Bunion Surgery
- Recovery from bunion surgery varies depending on the specific procedure performed.
- Immediately after surgery, the foot is placed in a surgical shoe or boot, with instructions to keep the foot elevated and use crutches.
- The first 2-4 weeks require rest and limited activity while keeping dressings clean and dry.
- During 2-6 weeks, patients may begin partial weight-bearing in their surgical shoe or boot and start gentle range of motion exercises for the big toe.
- The 6-12 week period involves gradual transition to regular, supportive footwear while continuing exercises to improve foot strength and flexibility.
- At 3-6 months, patients can return to most normal activities, including low-impact exercise, though swelling may persist for several months.
Post-Achilles Tendon Surgery
- Rehabilitation after Achilles tendon surgery requires patience and strict adherence to the surgeon's protocol.
- The first 2-4 weeks involve ankle immobilization in a cast or boot with non-weight-bearing status.
- During 4-8 weeks, patients typically wear a walking boot with wedges to protect the healing tendon while starting partial weight-bearing and gentle range of motion exercises.
- The 8-12 week period brings gradual increase in weight-bearingand more intensive physiotherapy to regain strength and flexibility.
- 3-6 months post-surgery allows walking without the boot while focusing on calf muscle strengthening and gait improvement.
- 6-12 months represents expected return to previous activity levels, including sports, though complete recovery may take up to a year.
Post-Ankle Ligament Surgery
- Recovery from ankle ligament surgery focuses on protecting repaired ligaments while gradually restoring strength and stability.
- The first 2-4 weeks require cast or boot immobilization with non-weight-bearing status.
- 4-6 weeks involve transitioning to a walking boot with partial weight-bearing and beginning physiotherapy for range of motion and gentle strengthening.
- During 6-12 weeks, patients wean off the boot and progress to advanced strengthening and balance exercises.
- 3-6 months allows return to most daily activities and sport-specific training.
Post-Foot and Ankle Fusion Surgery
- Ankle fusion joins the bones of the ankle joint together, requiring a lengthy recovery with significant non-weight-bearing periods.
- The first 6-12 weeks mandate strict non-weight- bearing in a cast or boot to allow proper bone fusion.
- After 12 weeks, once X-rays confirm solid fusion, patients begin weight-bearing in a walking boot.
- 3-6 months involves transitioning to regular footwear while continuing physiotherapy to improve gait and function.
- 6-12 months allows return to most activities, though patients will have limited up- and-down ankle motion.
Total Ankle Arthroplasty
- For individuals suffering from debilitating ankle arthritis, total ankle arthroplasty (ankle replacement surgery) offers a promising solution to alleviate pain and restore function. This sophisticated procedure involves replacing the damaged ankle joint with an artificial prosthesis designed to eliminate arthritis pain while preserving natural ankle motion.
- Understanding Ankle Arthritis begins with recognizing it as a degenerative joint disease characterized by cartilage breakdown in the ankle joint. This cartilage serves as a cushion between bones, and its deterioration leads to pain, stiffness, and reduced mobility. The most common causes include previous ankle trauma such as fractures or severe sprains, inflammatory conditions like rheumatoid arthritis, and age-related wear and tear.
- The Ankle Replacement Prosthesis typically consists of three essential components: a titanium metal component attached to the tibia (shin bone), a cobalt-chrome piece connected to the talus (ankle bone), and a polyethylene plastic liner placed between the two metal components to allow smooth joint gliding. This design effectively eliminates arthritis pain while maintaining joint motion, contrasting with ankle fusion which sacrifices motion to eliminate pain.
- Surgical Candidacy requires careful evaluation, with ideal candidates being individuals with end-stage ankle arthritis who have not responded to conservative treatments such as medication, bracing, and physical therapy. Patients should maintain good overall health and realistic expectations about surgical outcomes. Factors that may preclude candidacy include severe ankle deformity, poor bone quality, and active infection.
- Long-term Outcomes demonstrate the effectiveness of modern ankle replacement technology, with studies showing that over 90 % of implants remain functional at 10 years post-surgery . With proper care and activity modification, ankle replacements provide lasting pain relief and improved quality of life for many years. Should implant wear or loosening occur, revision surgery remains an option.helping you regain mobility and improve your quality of life.
Ankle Arthroscopy
- Ankle arthroscopy represents a minimally invasive surgical approach that allows orthopedic surgeons to visualize, diagnose, and treat problems within the ankle joint through small incisions called portals. A tiny camera (arthroscope) inserted into the joint transmits images to a monitor, providing clear visualization of the ankle's interior while specialized instruments perform various procedures through additional small incisions.
- Advantages of Arthroscopic Surgery include significantly less post-operative pain due to minimal tissue trauma, faster recovery times allowing quicker return to normal activities, smaller scars resulting in better cosmetic outcomes, and lower complication risks including reduced infection rates compared to traditional open surgery.
- Arthroscopic Procedures encompass a wide range of treatments.
- Osteochondral Defect (OCD) Treatment addresses cartilage and underlying bone injuries of the talus through removal of loose fragments and healing stimulation via microfracture techniques or cartilage transplantation.
- Arthroscopic Ankle Fusion provides a minimally invasive alternative to traditional open fusion surgery for severe ankle arthritis, using the arthroscope to remove remaining cartilage before securing bones with screws for fusion.
- Cheilectomy for Ankle Impingement removes bone spurs and inflamed soft tissues that cause pinching and motion limitation, often performed arthroscopically for quick recovery.
- Additional procedures include loose body removal of bone or cartilage fragments, synovitis treatment for joint lining inflammation, ligament repair in select cases, and joint irrigation for infection management.
- Recovery from Arthroscopic Surgery typically allows same-day discharge with recovery varying by specific procedure performed. The process generally involves initial rest, ice, compression, and elevation, followed by gradual activity return and physical therapy programs focused on restoring range of motion, strength, and balance.
Minimally Invasive Bunion Surgery
- Bunions (hallux valgus) represent common foot deformities occurring when the big toe points toward the second toe, creating a bony bump at the foot's side near the big toe base. These deformities can cause significant pain and difficulty finding comfortable footwear, often resulting from genetic factors combined with tight, narrow shoe wear.
- Minimally Invasive Bunion Surgery (MIS) utilizes modern surgical techniques to correct bunions through several small keyhole incisions rather than traditional large incisions. Surgeons employ specialized instruments to cut and realign foot bones, correcting the bunion deformity before securing bones in their new position with small screws.
- Advantages of MIS Bunion Surgery include reduced post-operative pain from smaller incisions and decreased soft tissue dissection, faster recovery allowing earlier walking and shorter overall recovery times, minimal scarring from keyhole incisions providing better cosmetic outcomes, decreased swelling due to reduced tissue trauma, and lower complication risks including reduced infection rates from smaller incisions and less tissue damage.
- Surgical Candidacy encompasses most patients with bunions, though the optimal surgical approach depends on bunion severity and individual factors. Orthopedic surgeons evaluate each case to determine if MIS bunion surgery represents the appropriate choice for individual patients.
- Recovery Process typically allows immediate post-operative walking in a surgical shoe, with physical therapy potentially recommended to restore foot range of motion and strength. Most patients return to normal activities within weeks to months, representing significantly faster recovery compared to traditional open surgery approaches.