The .gov means its official. In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. The patient may have to stay in the cast for 4 to 6 weeks. Courtesy and kind would be an understatement. Arrange for someone to drive you home as you will not be able to drive yourself post surgery. Rehabilitation exercises. This may relieve pain and improve movement of your leg. Although the risks are low, the most common complications include: In some cases, a second surgery may be required, particularly if the osteotomy does not heal. Same with driving it could take you six weeks to be back behind the wheel. High tibial osteotomy. In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. Toe Presses - put your toes up against a wall or solid surface to flex and stretch them. Unicompartmental (Partial) Knee Replacement. Furthermore, the moment the bone cartilage actually wears away unevenly, the gap located between the tibia and femur decreases in size. In certain conditions, a technique known as osteostomy can be used as a way to realign the knee and take the pressure off from the damaged side. This is called a High Tibial Osteotomy or H.T.O. Would highly recommend. Keep your cast clean and dry. TTO is surgery to place your patella (knee cap) in the correct position. BSSC Research Foundation | Suzanne L. Miller, M.D. A small bone called the patella (kneecap) rests on a groove on the front side of the femoral end. Before I came back in for my follow up and had the same great experience. The lower end of the thighbone meets the upper end of the shinbone at the knee joint. 36, 45 The percutaneous osteotomy occurs roughly 8 cm proximal to the knee joint line. The procedure was first performed in Europe during the 50s and was brought to the US in the 60s. The procedure is performed to correct bowed legs, where the legs curve outward and place an excessive load on the inside of the knee, leading to cartilage loss and arthritis in this region. Rebecca K. - What a true burst of sunshine. As with any surgical procedure, there are risks involved with osteotomy. You should refrain from alcohol or tobacco at least 24 hours prior to surgery. He had is team ready at the hospital and operated on me within 6 hours after my injury. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. Synovial fluid within the joint aids in smooth movement of the bones over one another. Dr. Karkare is very knowledgeable, helpful, and caring. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. Please turn on JavaScript and try again. Patients who have underwent tibial osteotomy are usually kept in the hospital for 1-2 nights following an HTO. You won't want to put pressure or stress on your heeling foot so running is probably not going to happen soon after a bunionectomy. In most cases, patients go home 1 to 2 days after an osteotomy. You may need x-rays or a CT scan. Surgical management of persistent intoeing gait due to increased internal tibial torsion in children. Applying the 3.5 mm 90 LCP allows immediate postoperative full weight bearing. Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Please enable it to take advantage of the complete set of features! This can put extra stress on either the inner (medial) or outer (lateral) side of your knee. Medications will also be prescribed as needed for symptoms associated with anesthesia, such as vomiting and nausea. A written consent will be obtained after the surgical process has been explained in detail. He really takes his time and explains treatment options. LHFs result in malunion, loss of correction, and recurrence of symptoms adversely affecting clinical outcomes. average = 0 to -10 degrees internal rotation during infancy (which gradually laterally rotates to 15 degrees external rotation during growth), greater than 15 degrees internal rotation, usually not indicated unless other conditions present (see above), CT or MRI can be utlized for surgical planning (in the few cases that require surgery), Medial deviation of the forefoot (abnormal heel bisector), normal hindfoot, Internal rotation >70 degrees and < 20 degrees of external rotation, In-toeing associated with the following necessitates further work-up, family history positive for rickets/skeletal dysplasias/mucopolysaccharidoses, bracing/orthotics do not change natural history of condition, derotational supramalleolar tibial osteotomy vs. proximal osteotomy, child > 6-8 years of age with functional problems and, associated with lower complications than proximal osteotomy, intramedullary nail fixation if skeletally mature, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis. During rehabilitation, a physical therapist will give you exercises to help maintain range of motion in your knee and restore your strength. Copyright 2023 Lineage Medical, Inc. All rights reserved. The lower end of the thighbone meets the upper end of the shinbone at the knee joint. If it wasnt for Dr. Karkares expertise she never would have been able to work. Osteotomy material should be removed 1 year postoperatively. HIGH TIBIAL OSTEOTOMY REHABILITATION PROTOCOL This protocol was developed for patients who have had a high tibial osteotomy. The . There was confirmed patellar instability in five knees, and patellofemoral pain without instability in 31. tibial torsion. Have you undergone a bunionectomy? A staff nurse will monitor blood oxygen levels and other vital signs as the patient recovers. Depending on the patients medical history, social history, and age, routine blood work and imaging may be ordered for safely conducting surgery. We are not attorneys. The incidence of lateral hinge fractures (LHFs) during medial opening wedge high tibial osteotomy (MOW-HTO) is unacceptably high, especially with distractions >10 mm. His expertise gave me my life back. 1989; 71: 1040-1043. Very friendly and definitely an asset to the practice! In any case, intracompartmental decompression by fasciotomy is recommended. Dr. Karkare put my fears to rest . A cast will be placed beginning at the pin and covering the entire leg and foot which holds the legs from moving while the new bone develops. The site is secure. I would highly recommend him. x\rHr}W`-'{f7ffw( Instructions on cast care and bathing will be provided. PMC Tibial osteotomies are often performed for knee injuries such as total lateral compartment collapse following a motor vehicle accident. indications. 2018 Aug;30(4):286-292. doi: 10.1007/s00064-018-0552-x. Taking away or incorporating a kind of wedge on the lower thighbone or upper shinbone can help in fixing the problem. A general or regional anesthesia is administered. endstream endobj startxref This is done through a small stab wound at the level of the break. Information is also obtained on any medications, vitamins, or supplements being taken by the individual. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. This procedure is sometimes called a high tibial osteotomy (HTO). Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Everything you need to know about bunion surgery! The information posted is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship or a doctor-patient relationship nor shall the information be used to form an legal or medical opinions. (Right) Osteoarthritis that has damaged just one side of the knee joint. Oper Orthop Traumatol. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. ;OWSd"S7@YpB$v$exYe[*tYlvn[2l.v-O.+Y>}k~Nyw].eR+K8 Your provider will talk to you about how to prepare for surgery. Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Your surgeon performs an osteotomy (surgical cut of the bone) of the tibia and fibula, normally above the ankle. Unauthorized use of these marks is strictly prohibited. Arhrodesis which requires screws or metal plates to correct the bunion and damaged joint. Information regarding any allergies to medications, anesthesia, or latex is obtained. Very friendly office and I'm glad to be a patient here. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. This passes under the anterior compartment and the peroneal . Waltham, MA 02451, 40 Allied Drive Office very clean. The appropriate test, x-rays were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Pain management. Back then, it was referred to as High tibial osteotomy.. Internal Tibial Torsion is a common condition in children less than age 4 which typically presents with internal rotation of the tibia and an in-toeing gait. Technique and results in patients with neuromuscular disease. Tibial osteotomy was first performed in Europe in the late 1950s and brought to the United States in the 1960s. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!! Your child being cross-legged during growth in the uterus causes it. J Am Podiatr Med Assoc. While bunion surgery recovery time varies from patient to patient, expect six to eight weeks before you're fully recovered. Nevertheless, it remains an option for many patients. This is a condition characterized by twisting of the tibial bone of the lower leg, causing malalignment of the knee and ankle with an appearance of an inward or outward turning of the feet. Clipboard, Search History, and several other advanced features are temporarily unavailable. With an oscillating saw, your surgeon will cut along the guide wires, and then either place or remove a wedge of bone, depending on the technique used. Broke my ankle three places on a Saturday. Toe marbles - pick up a marble with your big toe. Physio.co.uk have clinics located throughout the North West. %%EOF Well, bunion surgery removes the bump in the foot! The patient should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery. A staff nurse will monitor blood oxygen levels and other vital signs as the patient recovers. He takes time to listen and offer suggestions to help you get better. .elizabeth .thank you so much . Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. 2021 Jan 27;8(2):86. doi: 10.3390/children8020086. If more than 20 rotational correction of the tibia is planned, careful decompression of the peroneal nerve is essential in proximal tibial rotational osteotomies or, alternatively, a diaphyseal or distal derotation site should be chosen. We have immediate appointments available today. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Before your procedure, a doctor from the anesthesia department will evaluate you. Recovery Time For Tibial Osteotomy. Please note this protocol is a guideline. lt=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s" title=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s">. This procedure is ideal for younger patients who are suffering from pain brought by misalignment and instability. Brand new office, same great doctors! Dr.Karkare is the best. All material on this website is protected by copyright. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. rarely required. What a great place! Distal tibial/fibular derotation osteotomy for correction of tibial torsion: review of technique and results in 63 cases. The osteotomy needs time to heal, which takes approximately 6 weeks. You'll want your foot to rehabilitate nicely and toe exercises are important to follow through with post bunion surgery. 2012; 6: 81-85. : nf`l, @ , -, J Bone Joint Surg Am. [High tibial osteotomy combined with lateral retinacular release for the treatment of knee varus osteoarthritis with lateral patellar compression syndrome] J Child Orthop. This surgery realigns the knee joint in people who have knee arthritis. You are encouraged to walk with assistance as frequently as possible to prevent blood clots. Osteotomy literally means "cutting of the bone." Most commonly, osteotomies about the knee are cuts in the top of the shin or "tibia" bone. Synovial fluid within the joint aids in smooth movement of the bones over one another. Oper Orthop Traumatol. Metal hardware, such as pins are placed in the bone just below the knee to hold the bones in position. They are usually done to correct a knock-kneed alignment. The deformity is more obvious when standing. My orthopedic doctor kept recommending knee replacement . The meniscus, a soft crescent-shaped cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. You are encouraged to walk with assistance as frequently as possible to prevent blood clots. Rotator Cuff and Shoulder Conditioning Program. 2007 Mar;19(1):101-13. doi: 10.1007/s00064-007-1197-3. The staff is truly exceptional, they make you feel comfortable and welcomed. Mon - Fri: 8am - 8pm Dedham, MA 02026, Home | Disclaimer | Privacy | Sitemap | Feedback | Tell a Friend | Contact Us | Accessibility Statement | Careers. That said, an osteotomy procedure can also be performed together with other joint preservation treatments as a way to allow the cartilage to repair the tissue, encouraging it to grow without the need to deal with excessive pressure. The https:// ensures that you are connecting to the Your surgeon may also put your knee in a brace orcast for protection while the bone heals. J Am Acad Orthop Surgeons 2011; 19(10): 590-599. 2004 Nov;86(8):1170-5. doi: 10.1302/0301-620x.86b8.14479. Indications: A knee osteotomy operation typically lasts between 1 and 2 hours. Patients with additional surgery will progress at different rates. First, the surgeon cracks the tibia and the smaller fibula bone next to it, usually just above the ankle. 1973 Dec;55(8):1726-38 Consult a podiatrist if you're having a hard time finding something comfortable. Achieving the criteria of each phase should be emphasized more than the approximate duration. Weiner DS, Cook AJ, Hoyt WA, Oravec CE. Just like what has been mentioned earlier, its possible to do the activities you normally do, but keep in mind that there will be certain limits, because theres always the possibility of feeling pain and discomfort. There are three types of surgery to remove a bunion. 51.1 Introduction. In most cases, knee osteotomy is a great way to eliminate arthritis pain and prevent the need of having a total knee replacement surgery for 10-15 years. A metal plate is Multiple drill holes are made in the femur through a small lateral . Thank You. Pins will be removed at a later date after appropriate healing is confirmed. Amazing team!! 11). This brings the bones on the healthy side of the knee closer together and creates more space between the bones on the damaged, arthritic side. Due to the fact that this procedure is usually done for severe knee instability, you ought to know that its not impossible to except for a fully normal knee after the procedure and once the recovery time is complete. Dr. Vaksha was very thorough and kind. It usually develops when the bones of the knee and legs fail to line up properly. Osteotomy material should be removed 1 year postoperatively. On the other hand, if the correction is still small enough, then the pelvic bone graft wont even be necessary at all. Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result. [Components of the joint-sparing, combined bony and soft tissue correction of the cavovarus foot]. The patient may have to stay in the cast for 4 to 6 weeks. Bone malposition; Bone plate; Children; Lower leg; Tibial osteotomy. J Pediatr Orthop. Your surgeon will discuss each of the risks with you and will take specific measures to help avoid potential complications. I highly recommend this office to anyone whos looking for knowledgeable and kind orthopedic office. Aside from that, a high tibial osteotomy is also considered as one of the best methods to improve the time before the knee replacement procedures become necessary, because the advantages one can experience typically last for 8-10 years. Accessibility ``a`ad@ Ar&p"*d,{@H,bFlp<0 After the wedge of bone is removed, the tibia may be held in place with a plate and screws. National Library of Medicine Tweet us @womendotcom or follow us on Facebook and Instagram. By shifting the weight off the battered side of the joint, its possible to lessen the pain and improve the overall function of the knees. 4 0 obj It looks like your browser does not have JavaScript enabled. He took extra time with us and explained things so thoroughly. Keywords: The patient should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery. Osteotomies of the thighbone (femur) are done using the same technique. Your orthopaedic surgeon will discuss with you the technique they are going to use for your procedure. He listens to everything and explains everything I recommend him to everyone. Metal hardware, such as pins are placed in the bone just below the knee to hold the bones in position. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731. osteotomy site Osteotomy means cutting the bone. A tibial derotational osteotomy necessitates the surgeon to incise the bone, turn it appropriately to improve the alignment, and secure the bones in that position with metal hardware while they heal. Correct abnormal position/twist of the lower leg Correct in toeing or out toeing during walking What will happen during surgery? A thorough examination of the patient is performed by your doctor to check for any medical issues that need to be addressed prior to surgery. 4,9,10,24,33,34 Teitge 35 was the first to systematically describe the clinical use of derotational femoral osteotomy in . product of hip rotation, tibial torsion and shape of foot. Push against the towel and resist. Once awake, the patient may notice pain and discomfort. Repeat daily. You may be able to resume your full activities 3 to 6 months after surgery. We've rounded up some must-know information about bunion surgery recovery. Instructions on cast care and bathing will be provided. 0 It was the afternoon of Friday Sept. 24. Knee osteotomy is used when a patient has early-stage osteoarthritis that has damaged just one side of the knee joint. Surgery can be a scary and painful thing! Opioids can provide excellent pain relief, however, they are a narcotic and can be addictive. Your surgeon will give you instructions about when weight bearing can begin. Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up. According to Foot Health Facts a bunion is "a bump on the side of the big toe." Perpendicular osteotomy at the intersection of midshaft to distal shaft. Tibial derotation osteotomy was indicated if the painful and/or unstable patellofemoral syndrome was associated with least 20 of torsion, measured clinically and usually confirmed on computed tomodensitometry (CT scan). They will review your medical history and discuss anesthesia choices with you. MeSH This is a condition characterized by twisting of the tibial bone of the lower leg, causing malalignment of the knee and ankle with an appearance of an inward or outward turning of the feet. Refrain from strenuous activities or lifting heavy objects for a month or two. But if you stay off of your foot and follow instructions made by your doctor, you could be seeing less swelling sooner. measure the angle formed by an line from the lateral to the medial malleolus, and a second line from the lateral to the medial femoral condyles. Recovery from osteotomy is typically longer and more difficult because you may not be able to bear weight on your operated knee right away. This would result in a bow outward or inward. nonsteroidal anti-inflammatory drugs (NSAIDs), To transfer weight from the arthritic part of the knee to a healthier area, To prolong the life span of the knee joint. The stable fixation with locking plates provides stability without loss of correction at follow-up. Your surgeon will insert a plate and screws to hold the bones in place until the osteotomy heals. Anesthesia can be either general (you are put to sleep) or spinal (you are awake, but your body is numb from the waist down). endstream endobj 11 0 obj <>>> endobj 12 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 13 0 obj <>stream A 20-year-old patient with a bow-legged left knee. JBJS. Selber P, Filho ER, Dallalana R, Pirpiris M, Nattrass GR, Graham HK. (Left) A normal knee joint with healthy cartilage. An 18-month-old girl is brought to clinic by her mother for in-toeing. My appointment with Dr. Vaksha was amazing. Your surgeon will make an incision at the front of your knee, starting below your kneecap. derotational supramalleolar tibial osteotomy vs. proximal osteotomy. A cast will be placed beginning at the pin and covering the entire leg and foot which holds the legs from moving while the new bone develops. A staff nurse will monitor blood oxygen levels and other vital signs as the patient recovers. Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office.. It might take a year to fully recover, according to WebMD. After a Tibial Osteotomy, you can still participate in your favorite activities without worrying at all. Osteoarthritis can develop when the bones of your knee and leg do not line up properly. J Bone Joint Surg Br. It can allow a younger patient to lead a more active lifestyle for many years. Tibial osteotomy. Increased age, smoking, impaired nutrition, impaired glucose control, and other things can also affect the duration of how long you should wear clutches. Tibial (Shin Bone) Derotation Osteotomy Why is this surgery reco mm ended? After the follow-up, your surgeon will tell you when it is safe to put weight on your leg, and when you can start rehabilitation. An individualized physical therapy protocol is designed to strengthen muscles and restore muscle function. Sunday: 9am - 4pm. Arrange for someone to drive you home as you will not be able to drive yourself post surgery. Surgical management is indicated in children > 6-8 years of age with functional problems andthigh-foot angle >15 degrees. Tibial osteotomies are often performed for knee injuries such as total lateral compartment collapse following a motor vehicle accident. For most patients, osteotomy is successful in relieving pain and delaying the progression of arthritis in the knee. Very caring, profesional, and friendly!! Your child's surgeon will make a cut in the front of the lower leg. The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. Complete Orthopedics should be your choice! I am so happy he is my doctor. Wedge JH, Munkacsi I, Loback D. Anteversion of the femur and idiopathic osteoarthrosis of the hip. The information on this website is for general informational purposes only. Great staff. You'll need to take care of yourself after surgery on your bunion(s). A follow-up appointment for X-rays and pin removal 4 weeks after surgery will be scheduled as well as to monitor your overall progress. Damage to adjacent soft tissue structures. FOIA Proximal tibial osteotomy, also called a high tibial osteotomy, is a surgical procedure to cut and re-align the upper part of the tibia or shinbone. Fibular Osteotomy The indication was formal in all patients with more than 30 of torsion. All Rights Reserved. You are advised to keep your leg elevated while resting to prevent swelling and pain. [Torsion and torsional development of the lower extremities]. This surgery corrects bowlegged alignment that's putting too much stress pressure on the inside of your knee. Truth be told, there wouldnt be a need to do this. There are two basic indications for this surgery: The first involves the damaging effect of spasticity on the hip joint. The overall goals of the osteotomy and rehabilitation are to control joint pain, swelling, and hemarthrosis; regain normal knee flexion and extension; resume a normal gait pattern and neuromuscular stability for ambulation; regain lower extremity muscle strength, proprioception, balance, and coordination for desired activities; and achieve the 6MJ>8Ix 43 0 obj <>stream Highly recommend. Proximal tibial derotation osteotomy for torsion of the tibia: a review of 43 cases. My mom had a total hip replacement by dr karkare. %PDF-1.5 % The patient will be transferred to the recovery area to be monitored until awake from the anesthesia. Tibial derotation and osteotomy surgery is a surgical procedure to correct the alignment of the lower leg that is often required to treat tibial torsion (twisting of lower leg). Diagnosis is made clinically with a thigh-foot angle > 10 degrees of internal rotation in a patient with an in-toeing gait. -, J Orthop Trauma. When I see him he makes sure to review my progress in detail. Dr Vaksha, is a great doctor very professional knows what he talking about. Treating pain with medications can help you feel more comfortable, which will help your body heal faster and recover from surgery faster. Likewise, a procedure known as the high tibial osteotomy can also be used to reconfigure the affected knee joint. 2018 Mar;121(3):191-198. doi: 10.1007/s00113-017-0452-9. Assuming an uneventful postoperative course, consolidation of the fracture can be expected within 4-6 weeks. You should refrain from alcohol or tobacco at least 24 hours prior to surgery. u&bCa;\2@>\'a4#gw>t,Cg)t4/wVh8D6sC\.C% Ni}ka>8:t]6 Your surgeon then turns or rotates the tibia bone accordingly to achieve a proper alignment. After surgery, you will feel some pain, but your surgeon and nurses will make every effort to help you feel as comfortable as possible. X-rays will be taken so that the surgeon can check how well the osteotomy has healed. Recovery from osteotomy is typically longer and more difficult because you may not be able to bear weight on your operated knee right away. Fulkerson osteotomy. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. This would be her third time under the knife in the past year. Over time, this extra pressure can wear away the smooth articular cartilage that protects the bones, causing pain and stiffness in your knee. -. )LDN^+_OIj.b[~*2kt9EZ+uM|,>WEczKOpcFpFiY`U,fVgN};UN?6cB{3,uZ.;S/gl6J]fZ3`mO.-}HhD.[7]= rC,dRj{ Setting up physical therapy is right there as well.I'm so glad I found this place. This will depend on what knee is affected. Differences between Two Methods to Stabilize Supramalleolar Osteotomies in Children-A Retrospective Case Series. -j[MjHiz4q?u2 He explained everything to us, and the office staff set everything up for us and made the process easy. Total knee replacement was the only viable option. Because you might be in a cast, wheelchair, or other bandage walking on your foot is a bad idea.