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| Figure 1 – Ankle arthritis, seen as a reduction in the joint space between the tibia and talus |
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| Figure 2 – Arthroscopic ankle fusion |
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| Figure 3 – Ankle replacement – front and side views |
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| Figure 4 – Mr Taylor is seen here performing an ankle arthroscopy |
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| Figure 5 – An illustration of the various types of Moje ceramic joint available |
Achilles Tendon | Ankle Arthritis | Ankle Sprains
Ankle Disorders
Ankle Arthritis
Arthritis of the ankle occurs when the cartilage that lines the ankle joint, which is the joint between the tibia (shin bone) and talus (main ankle bone) is worn (see figure 1). It may occur through simple wear and tear or can arise as a result either of trauma to the ankle such as a previous fracture, or as a result of an inflammatory condition such as rheumatoid arthritis.
Symptoms of Ankle Arthritis
The two main symptoms that occur in ankle arthritis are pain across the front of the ankle joint and stiffness causing a loss of movement. There may also be some swelling. The symptoms tend to occur whilst walking and often cause a limp.
As the arthritis progresses, there may be destruction of the bony anatomy of the ankle causing the ankle joint and alignment of heel to become deformed.
Treatment Options for Ankle Arthritis
1. Non Operative Treatment
The non-operative treatment options include anti-inflammatory tablets, the use of a walking stick and occasional use of splinting. These tend to work only in very mild cases and once the disease has progressed beyond a certain level, this treatment may not provide satisfactory pain control.
2. Injection
We will occasionally consider injection of the ankle joint, again in mild cases or if the diagnosis is not certain. The injection involves the insertion of a long acting local anaesthetic combined with a steroid into the ankle joint. The effects of the injection tend only to be temporary and will often wear off within a few weeks or months.
3. Ankle Arthroscopy
This involves keyhole surgery through 2 small incisions at the front of the ankle. In mild cases of arthritis, this allows us to tidy up any loose cartilage and remove spurs of bone around the front of the ankle joint. We can also treat osteochondral lesions of the ankle joint through keyhole surgery. These are isolated areas of cartilage and underlying bone damage that often occur as a result of severe sprains of the ankle and can be the precursor for arthritis at a later date. As with injection and splinting, keyhole surgery and tidying up the joint tends to only be successful in mild to moderate cases of arthritis.
4. Ankle Fusion
A fusion of the ankle joint involves removing all residual cartilage of the joint and preparing the bony surfaces to allow the joint to fuse completely. This removes all movement from the ankle joint and is usually stabilised with 2 metal screws (see fig 2) or occasionally a large metal pin known as an intramedullary nail. This has been the conventional and proven method of treating ankle arthritis and has an excellent success rate in removing pain.
At the Dorset Foot and Ankle Clinic, the majority of ankle fusions are now performed through keyhole surgery. This significantly reduces the risk of wound problems and the risks of infection post-operatively. There is also a higher rate of successful union of the ankle fusion as the blood supply around the ankle joint is not significantly affected, as would be the case for a conventional open ankle fusion. The disadvantage of ankle fusion is that it creates increased stresses on the surrounding joints and may cause arthritis in these at a later date.
5. Total Ankle Replacement
Ankle replacement is the latest and most innovative means of treating ankle arthritis. It involves relining the bones of the ankle joint (the tibia and the talus) and the insertion of a plastic bearing between the two metal relining implants.
The advantage of ankle replacement over ankle fusion is that it preserves the majority of the up and down mobility in the ankle joint. This makes for a more normal walking pattern whilst still having the advantage of removing the pain from the ankle arthritis. In the past, there has been a high failure rate for ankle replacements. Here at the Dorset Foot and Ankle Clinic, we use the most modern prosthesis available today, which is the Mobility Ankle Replacement (De Puy) (see figure 2 & 3).
This has excellent short to mid-term follow-up and to date we have been very encouraged by the outcomes of patients having their Mobility Ankle Replacement performed at the Dorset Foot and Ankle Clinic. Not all patients with ankle arthritis are suitable for a total ankle replacement and either Mr. Taylor or Mr. Farrar would be pleased to discuss the treatment options with you in more detail when they see you at the Outpatient Clinic.
