Ankle joint surgery

If physical examinations and imaging studies confirmed that the cause of the symptoms are acute or chronic cartilage damage, or impingement of the ankle joint, surgery may become necessary in case of ineffective non surgical treatments.

Different types of damages may develop most frequently as a result of previous injuries or overload. Ankle impingement, and different types of cartilage damages affect athletes in the first place, as the consequence of overload, but these could also be caused by poor foot statics, traumas, and rheumatological conditions.

What is to know about the cartilage damage of the ankle?

• Thinning, fragmentation, injury, or ulceration develops on the surface of the 3-5 mm thick hyaline cartilage, which covers the joint surfaces.
• The symptoms may remain subtle for a long period of time depending on the size and the depth of the abnormality, but later on, they may intensify and lead to a feeling of discomfort, pain, or movement disability.
• The loading capacity and the range of motion of the joint is significantly reduced due to cartilage damage.

What are the main symptoms of the disease?

• Pain which is characterized by:
  • Recurring pain
  • Increases on load
• Feeling of obstruction, bone cracking, swelling
• Reduced range of motion, limping
• Reduced load capacity

What treatment options are available?

Basically, there are two types of treatment options available:

Non surgical (conservative) treatment

Aims:

• Reducing pain
• Stopping the increase of cartilage damage
• Increasing muscle strength, improving the range of motion
• Reducing limping
• It is mostly recommended for cartilage damage which was detected at an early stage.

Methods:

• Taking cartilage repair supplements, anti-inflammatory drugs, painkillers
• Administration of injections which repair cartilage surfaces
• Physiotherapy, body weight control, body weight loss
• Elimination of risk factors
• Rheumatological treatments: physical therapy, medical spa treatments (balneotherapy)

Surgical treatment

The physician may recommend surgery if the non-surgical treatment options are ineffective, and the diagnosis is confirmed by clinical MR/CT and X-ray scans.

• In order to stop the degenerated cartilage segments with arthroscopy to detach further, the detached or fibrotic cartilage is removed, and the surface is smoothed out. A healing process may start after this, and the cartilage ulcerations will potentially be covered by fibrous cartilage.
• Scar tissues and bone spurs, which potentially cause impingement, are removed.
• Healing processes only start in case of smaller, isolated cartilage damages; in case of an extensive damage, joint fusion or prosthesis implantation may help according to the current state of science.
• In case of an arthrodesis, the talocrural joint is fixated after the remaining cartilage surface is shaved down. Following this, the joint is no longer painful, and patients can walk normally with it, since the ankle joint is already used to the reduced range of motion. Although its disadvantage is that the neighboring joints will sooner or later wear out due to the increased load.

The process of ankle surgery:

• One of the above surgeries or their combination is performed through standard surgical penetrations by inserting a camera and other instruments in the talocrural or talotarsal joints.
• In case of joint fixation, screws are implanted with an X-ray image intensifier.
• A suction drain is inserted into the surgical site, if necessary.
• Cover dressing and elastic bandage are applied, followed by a plaster cast or plastic boots.

What happens if the justified ankle surgery is not performed?

• The pain is expected to increase further.
• The movement disability may aggravate.
• The quality of life keeps deteriorating.
• The effectiveness of a surgery performed later may decrease.