Surrey Foot and Ankle Clinic Surrey Foot and Ankle Clinic

I am concerned about ankle arthritis and its treatment 

What sort of operations are available for ankle arthritis?

 

Arthroscopic debridement – or cleaning out - of the joint

Cleaning out of the ankle is usually undertaken through an arthroscope. Under an anaesthetic a ‘telescope’ is inserted into the joint through two or three small incisions at the front of the ankle. The ankle is washed out with fluid and the loose bits of ‘cartilage’ and bone are removed. If there are any bony spurs which block movement, these can be removed at the same time. This does not reverse the damage done to the cartilage though. This procedure can relieve pain and reduce the stiffness of the joint temporarily. Please look for our separate information page on ankle arthroscopy.

What are the potential complications?

As with any surgical procedure there can be complications. With ankle arthroscopy these include:

1. Approximately two thirds of people obtain significant pain relief benefit from the surgery but, in one third, the symptoms are largely unaltered or even get worse as a result of the arthritis progressing.

2. Infection: this is rare, with significant infection occurring in less than 1 in 1000.

3. Wound healing problems: In rare cases the arthroscopy portals (incisions) can be slow to heal.

4. In rare cases nerves in the skin can become entrapped in the scars, or damaged where the arthroscope is inserted. This can usually be cured with further surgery.

 

Fusion of the ankle joint

Fusion of the ankle to treat arthritis is the ‘tried and tested’ treatment for severe ankle arthritis. The joint lining is removed and the joint is made permanently stiff, initially with screws and later by the bone healing across the joint. The medical term for fusing a joint is ‘arthrodesis’. Fusion of the ankle is successful in about 95% of cases and pain is abolished as there is no joint remaining. There is no ‘up and down’ movement at the ankle after a successful fusion but, in fact, approximately 30% ‘up and down’ movement of the foot remains because of flexibility in other joints in the foot. This means that with a successfully fused ankle joint, a patient can still walk normally without a limp or significant pain.

Fusion can be performed with an open incision. Severe deformity can only be treated using an open technique. Occasionally, extra bone is needed at the fusion site and this can usually be taken through the same incision or, if more bone is required, through a separate incision at the pelvis.

What are the potential complications following open fusion?

As with any open procedure, there is the potential for wound healing problems and postoperative pain. After an open fusion you will be in a plaster cast for 12 weeks and will not be allowed to bear weight for the first 6 weeks. The cast is from below the knee to the toes.

The alternative to open fusion is an arthroscopic fusion. The joint surface is prepared with powered and hand instruments inserted through small incisions at the front of the ankle. The raw bone surfaces are screwed and held together by screws inserted under x-ray guidance. The advantage of this operation is that the incisions are much smaller.

How long will it take to recover following fusion?

Following both open and arthroscopic ankle fusion, you will be seen in clinic at 2 weeks to have your stitches removed and your plaster completed or changed. An X-ray is taken at the 6 week appointment to check if the joint is fusing. All being well, you may be allowed to bear weight at that stage. At 12 weeks, the plaster is finally removed and as long as the bones have healed you are allowed to bear weight on the unprotected foot. Often, you may be issued with a removable boot/cast as a ‘step down’ from the cast. Following removal of the cast the ankle will swell and become a little more uncomfortable. A flight sock may help reduce the swelling. The symptoms will gradually settle over the year following surgery. It will be at least 9 to 12 months before the benefits of surgery become fully apparent. In the longer term, normal walking and golf are possible if the surgery is successful, but only a few patients will be able to jog. A small modification to the sole of your shoes (rocker sole) or MBT shoes can help reduce 'wear' of other joints in your foot after the ankle has been fused.

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