Dr Ling 02 9650 4782       Dr Lunz 02 9650 4835
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  • Dr Jeff Ling - Sydney Foot & Ankle Surgeon
  • Foot & Ankle Surgeon Sydney
  • Dr David Lunz - Foot & Ankle Surgeon

Ankle Arthritis

Dr Jeff Ling & Dr David Lunz


Sydney Orthopaedic Specialists: Foot & Ankle Institute

Ankle arthritis is a common condition often developing from prior injury to the ankle such as ankle fracture, or recurrent ankle sprains, although it can occasionally occur due to wear and tear alone. The main treatment of ankle arthritis historically has been ankle arthrodesis or “fusion”. In this procedure, the ankle bones are held together with metal hardware till the body’s biology fuses them together in a process very similar to fracture healing. This procedure is very successful in relieving pain and remains the gold standard of care.

Non-operative treatment of ankle arthritis

This includes analgesia, use of a brace, shoe modifications including MBT type “rockerbottom” shoes, as well as injection therapy of cortisone.

When this fails and the patient's pain becomes disabling and/or their function becomes limited, surgical intervention is offered.

Surgical treatment of ankle arthritis

Surgical treatment of ankle arthritis is divided into three main categories:

  1. Arthroscopic removal of the spurs, which is a "clean out" of the arthritis in your ankle.
  2. Ankle arthrodesis (“fusion”), which is still the most common and reliable treatment for ankle arthritis.
  3. Ankle replacement, which is a new and exciting treatment for ankle arthritis.
Ankle Arthroscopy
Arthroscopic treatment of ankle arthritis involves putting a small camera in your ankle joint via keyhole incisions and removing spurs. This treatment usually works for mild ankle arthritis that is limited to one part of your ankle in patients who have a spur. Spurs can occur after a sprain or repetitive stress at the front of the ankle such as from kicking a soccer ball. Patients then lose movement as the spurs can act as a block to motion but they can function pretty well otherwise. This surgery is done to try to return the patient to their sport by improving their movement, and is never done for advanced ankle arthritis.

Ankle Arthrodesis
An ankle arthrodesis or “fusion” is still the most common procedure performed for ankle arthritis in which the tibia and talus bones are fused together with screws. After an ankle fusion, contrary to popular belief, your foot still has some up and down movement. Your normal ankle motion is due to a combination of your ankle joint (tibiotalar joint) and the transverse tarsal joints at the midfoot. As we fuse just the tibiotalar joint, the transverse tarsal joint still moves up and down, giving the foot an arc of motion of about 20 degrees after an ankle fusion. Additionally, side-to-side motion of the foot is preserved, as this movement is performed by the subtalar and transverse tarsal joints, and not the ankle.

During a fusion, we remove the diseased cartilage inside your ankle joint, and usually place bone graft either from your heel bone or occasionally synthetic graft, in the space. The bone graft functions as a type of grout or filler, which makes the fusion heal faster. The procedure can be done via a traditional open approach or arthroscopically, as long as the deformity is not severe. The procedure usually requires a hospitalization of 1 to 2 nights. The postoperative course usually involves a plaster cast and not bearing weight on the ankle for 6 weeks. Crutches or a walker are required during this time. At the 6 week mark, an x-ray is taken and if the fusion is progressing well, we transition you to a removable boot, and allow you to start putting some weight through it. By 10 weeks, most patients are able to walk just in the boot and start to transition to a shoe sometime around week 12. Please note, however, that it takes 6 to 9 months to completely recover from an ankle fusion.

Overall, an ankle fusion is a very successful operation in terms of pain relief and restoring function by relieving pain. Once the ankle has fused, it is quite durable. Many patients work physically demanding jobs, walk long distances, hike, cycle and ski on fused ankles, however, the fused ankle will never function like a completely normal ankle.. Patients are encouraged to discuss specific hopes for return to activity with us. Running and similar activities are generally not recommended.
Ankle Replacement
Ankle replacement is a newer technique for the treatment of ankle arthritis and it is an exciting time for suitable patients and us, their treating surgeons. With correct patient selection, ankle replacement is no longer an experimental option, but a viable option for the treatment of ankle arthritis. The ankle joint is more difficult to replace than the hip and knee because of the tremendous forces across the ankle joint and the limited soft tissue envelope around it. These forces across the ankle are 5-6 times higher than across the hip or the knee and occur over a much smaller surface area, which means wearing out of an ankle replacement is much more of a problem than in hip or knee replacements. Whilst continual improvements in ankle replacement surgery are being made, they are still less reliable than a fusion in the long run although they offer the benefit of an improved arc of motion of the foot. They are generally reserved for thinner patients over 65 with minimal deformity. We currently use the Salto ankle replacement manufactured by Tornier, which has arguably the best results worldwide, and a published survival rate of over 90% at ten years.

Useful Links

Click below to learn more about:
    The Salto Ankle Replacement system
    Ankle Arthritis from the American Academy of Orthopaedic Surgeons

Images

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Ankle Fusion

Salto Ankle Replacement

Salto Ankle Replacement

Salto Ankle Replacement

Salto Ankle Replacement

Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Patients should discuss their particular situation with the doctors of Sydney Orthopaedic Specialists: Foot & Ankle Institute.