Ankle arthritis

Ankle pain

What is it

Progressively painful condition cause by wearing away of the smooth joint surface by osteoarthritis. Caused pain and limited movement.

Non-surgical options

Referral to physiotherapy to allow strengthening of the muscles around the ankle. If the ankle is stiff and painful a rocker bottom shoe can prove very effective at allowing you to walk more comfortably and improve your gait (walking style or flowing movement.)  I will sometimes suggest an injection of steroid and local anaesthetic into the ankle both to decrease the pain and also to prove where the pain is coming from. I do this in the operating theatre with you awake and often use an X-Ray machine to ensure that the injection has gone into the correct place. After injecting your ankle I will see you back in clinic in 3 months to assess the short and medium term effect of the injection.

Surgical options

In cases of mild to moderate arthritic change I may offer you an arthroscopy. This is covered under the "Ankle Arthroscopy" section. When the ankle is severely worn out with arthritis and is painful I would recommend an ankle fusion. This means surgically removing the joint and joining the ankle bones together to form one solid bone. There are two ways of doing this: 

Arthroscopic 

When the overall shape of the ankle is reasonably normal I can prepare the ankle for fusion with two small (approximately 1cm) cuts over the front of the ankle and then hold the joint with two screws placed via two more small incisions over the inside (medial) side of your tibia (shin bone). 

Open fusion

If your ankle is more deformed then I use a longer cut over your distal fibula (bony bump on the outside of the ankle). This part of the fibula is removed and the ankle prepared under direct vision with the two screws used to hold it going in through the same incision. (The Distal fibula is not needed if the ankle has been fused so making it's removal safe.) People often ask how they will be able to walk if their ankle has no movement. Usually when it has got to the level of needing an ankle fusion there is very little movement left (and any movement there is, is painful) and so the fusion actually allows people to walk with a more normal gait as they now have a stiff but pain-free ankle, rather than their pre-operative stiff and painful one. The other joints in the foot allow significant compensatory movement. There is an option available for ankle replacement. This is not as reliable an operation as a fusion and certainly not comparable to replacement of other joints such as the hip in terms of its longevity. As such it is usually reserved for people of an older age and with lesser demand. This is not an operation that I carry out due to these reasons. I will be very happy to discuss the different options with you in clinic and if you decide you would like to pursue the replacement option I will refer you on to a trusted colleague who does perform this procedure.

Risks of surgery specific to this procedure

Non-union.

What to expect after surgery

  • One to two nights in hospital after the operation.
  • A local anaesthetic block is used around the ankle to decrease post-operative discomfort.
  • The patient must keep their foot up above the level of the groin for 23 hours every day for two weeks. This minimises swelling, decreases discomfort and reduces the risk of wound complications and infection.

Expected recovery milestones

  • At two weeks you will be seen for a wound check.
  • 6 weeks non-weight bearing in a plaster cast; 6 further weeks in a boot up to the knee, full weight bearing.
  • At the six week appointment an x-ray will be taken to check on the healing of the bone.
  • Between three months and one year there will still be some swelling and minor discomfort.