Ankle Reconstruction Melbourne

Ankle (and Hindfoot) Arthritis occurs when the cartilage of the ankle (or the joints below the ankle, also known as the hindfoot joints) wear away. Cartilage provides a smooth surface to allow these joints to carry out movement. It also protects and cushions the joints during weight bearing.

An arthritic joint loses its normal shape, and underlying bone is exposed. There may also be formation of bony spurs (or osteophytes) around the joint. It is less common than knee or hip arthritis but can be just as painful and debilitating.

Causes

Ankle arthritis most commonly occurs due to previous trauma such as multiple ankle sprains or a fracture (post traumatic arthritis). It may also be the result of long term “wear and tear” associated with your daily activities. Other causes include inflammatory diseases such as rheumatoid arthritis.

Symptoms

  • Pain may initially be noticed during walking but can worsen to fairly constant during the day and sometimes at night.
  • The ankle can swell and feel warm.
  • Foot or ankle may change shape and become very stiff.

What Imaging is Needed?

‘Standing’ x-rays must be obtained to accurately assess severity of the arthritis. In the earlier stages, it may only be evident on Magnetic Resonance Imaging (MRI) scan.

Standing X-rays are used in the assessment of ankle and hindfoot arthritis.

Non-Surgical Treatment

In many cases, it is appropriate to aim to avoid surgery. Lifestyle and activity modifications such as weight loss and low impact exercises may relieve your symptoms. Over-the-counter preparations such as glucosamine, fish oil and chondroitin may assist with general arthritis type symptoms.

Physiotherapy can help relieve symptoms by strengthening the muscles around the joint.

A visit to the Orthotist or Podiatrist might be useful. They should be able to provide you with advice about footwear and the use of walking aids. They can provide a customised shoe or insole that reduces movement at the painful joint.

In addition, pain killers prescribed by your Doctor to assist in reducing pain should be carefully monitored. Lastly, a cortisone injection has been shown to provide temporary relief.

Surgical Treatment

Surgical treatment is usually left for situations where non-surgical treatment has failed. The aim of surgery is to relieve pain and improve your quality of life. Mr Goldbloom performs a number of surgeries for ankle arthritis and it is important to take time at your consultation to discuss these in order to choose which is option is right for you.

Cheilectomy is a procedure that involves removal of bony spurs (osteophytes). This procedure is very simple and effective in cases where the spur is the major cause of symptoms.

Fusion or Arthrodesis: is often referred to as ‘the gold standard’ for this condition.This procedure involves removing the arthritis by deliberately stiffening the joint. This results in a loss of movement but can provide significant pain relief.

Realignment Osteotomy: this surgery involves reshaping the bones around the joint to redirect your weight-bearing over the non-arthritic part of the joint. Unlike a fusion, it has the benefit of allowing you to continue to move your ankle.

Ankle Replacement: similar to hip and knee replacement, the ankle joint can also be replaced. When compared with ankle fusion, it provides a similar level of pain relief but preserves some pre-operative motion of the ankle.

Post-operative Care for a Cheilectomy

  • When you go home it is very important to elevate the foot 23 hours a day above the level of your heart for two weeks.
  • Following a Cheilectomy, you can usually weight-bear straight away. A special shoe known as a “cam boot” may be provided to wear for 3-6 weeks after surgery for comfort.
  • You will have a consultation with Mr Goldbloom and the Wound Nurse Specialist approximately 2-3 weeks after your surgery. Leave your dressings intact until this review.
  • Physiotherapy will be required post-operatively. It will be tailored to you and how well you are recovering.

Refer to the Foot and Ankle Surgery information sheet for further post-operative instructions.

Post-operative Care for Fusion, Realignment Osteotomy & Ankle Replacement

  • When you go home it is very important to elevate the foot 23 hours a day above the level of your heart for two weeks.
  • You will have a consultation with Mr Goldbloom and the Wound Nurse Specialist approximately 2-3 weeks after your surgery. Leave your dressings intact until this review.
  • You will be required to non-weight-bear for 6 weeks and possibly partial weight-bearing after this.This will be confirmed at the time of surgery and at your 6-week review.
  • Physiotherapy will be required post-operatively. It will be tailored to you and how well you are recovering.

Refer to the Foot and Ankle Surgery information sheet for further post-operative instructions.

Rehab Protocol for Ankle Fusion

Week Exercises Boot Weight bearing Returning to Pre-Surgical Function
0-2 Hip and knee active ROM exercises Plaster NWB Staying home with the foot elevated above heart level for 23 hours a day
2-4 Hip, knee, ankle band resisted exercises. Toe AROM – wriggling, flexing, extending. Calf, shin muscles massage. Cam Boot NWB
4-6 Hip, knee, ankle band resisted exercises. Banded toe exercises – flexion, extension, toe squeezes, spreads, ball squeeze. Cam boot NWB
6-8 Gentle ankle AROM DF and PF. Calf and shin massage and stretching. Physio guided PF and DF mobilisations. Start DL heel raises, progressing to SL. Cam boot PWB progressing towards FWB as tolerated Return to work – sedentary occupation.
8-10** Physio guided gait and balance training. Continue exercises as above. Cam boot FWB if cleared by surgeon
10-12* Increase walking distance. Cam boot FWB Return to light duties – labour intensive occupation
12+ Physio guided, gradual return to pre-surgery activities eg. running, cycling. No boot May return to full duties (clinical assessment required) Return to sport at ~6 months

Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Please contact Mr Goldbloom's rooms to discuss if surgery is appropriate for your situation.