Arthritis of the Foot and Ankle

Ankle arthritis is a degenerative condition which is usually a result of previous trauma to the ankle joint. It can also be the result of auto-immune or inflammatory conditions. It results in pain, swelling and restriction in range of motion and often a deformity.

As with arthritis of the hip and knee, first line treatment is non-operative and consists of analgesia, anti-inflammatory medication, activity modification, judicious use of orthoses or braces and occasionally intra-articular injections. When non-operative treatment is not effective, surgery may be indicated.

Surgery for Ankle Arthritis

Surgery for ankle arthritis in broad terms is joint-preserving (arthroscopy and/or osteotomy) or joint sacrificing (arthrodesis/fusion or total ankle replacement). Joint-preserving surgery is generally indicated in mild to moderate disease. For severe ankle arthritis, ankle fusion and total ankle replacement are the preferred surgical options. There is much debate about which option is 'better' for certain patients.

Ankle Arthrodesis

This is a surgical procedure to fuse the bones of the ankle joint. It is also called an ankle fusion. It is usually performed under general anaesthesia and a block. I usually perform this procedure with the aid of arthroscopy (keyhole) to remove the remaining cartilage from the ankle joint surfaces and then use large screws to fuse the bones together. The ankle is immobilised in a plaster or camboot for 6-12 weeks after surgery during which time the bones of the ankle fuse together. There is still some up-down and side-to-side movement in the foot and this comes from the other joints in the foot.

Ankle Replacement

This is a procedure to resurface the main contact surfaces of the ankle joint. It is usually performed under general anaesthesia and a block. An incision is made on the front of the ankle and ankle joint bones are exposed. A jig is used to remove the existing diseased joint surfaces using a saw and chisels. Metal implants are then press-fitted into the new joint space and a polymer (plastic) liner is inserted between them. The advantage over ankle arthrodesis is the greater arc-of-motion of the foot. Unfortunately, this procedure is not suitable for many patients and is generally reserved for older patients.