Treatment at Mayo Clinic

By Mayo Clinic Staff

Many types of ankle surgery and treatment options are available at Mayo Clinic, depending on the age and activity level of the patient and the cause and severity of the condition. A foot and ankle specialist conducts a comprehensive evaluation to determine which type of ankle surgery is most appropriate for the patient. Treatment options include, but are not limited to, debridement, ankle fusion or ankle replacement.

To relieve the pain of mild osteoarthritis, Mayo surgeons may recommend debridement, a minimally invasive surgical procedure that involves cleaning up the cartilage around the ankle joint. Surgeons use an arthroscope, an instrument that permits small incisions, and insert a small camera to see the joint. Special surgical tools are used to remove damaged parts of the joint, loose pieces of cartilage and bone around the joint.

Ankle fusion is often recommended for people with severe ankle misalignment, osteoarthritis, an inability to move the foot due to a neurological lesion or a history of infection or dead bone. Ankle fusion generally is suitable for patients who are younger than 30 and wish to participate in high-impact physical activities. It also may be an option for larger patients. Ankle fusion usually allows patients to walk without a limp and without pain.

Ankle replacement surgery is often appropriate for patients who avoid high-impact activities, such as skiing, basketball and football. Ankle replacement may be better suited for people with near-normal alignment of the ankle, no history of infection in the ankle joint, and no dead bone (avascular necrosis). Most patients who have ankle replacement surgery have osteoarthritis, rheumatoid arthritis or arthritis caused by a prior trauma, such as a broken ankle.

Ankle fusion surgery

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Mayo Clinic foot and ankle specialists have expertise and experience in performing ankle fusion surgery and may perform minimally-invasive surgery when possible. Foot and ankle specialists use the newest surgical techniques and the most current technology available to effectively treat ankle conditions. Candidates for ankle fusion surgery may include patients with severe ankle misalignment, osteoarthritis or other ankle conditions.

To relieve ankle pain when cartilage has been damaged or destroyed, the bones of the ankle can be fused. Ankle fusion surgery involves the implantation of external or internal fixation devices. An orthopedic surgeon determines which type of fixation is most appropriate for each patient. In external fixation, surgical pins are fixed inside the leg and ankle bones to keep the bones in place, and an outer metal rod and pins hold the bones in place until they heal. More commonly, in an internal fixation approach using internal fixation, the cartilage at the ankle joint is removed, and the ankle and leg bones are compressed with plates and screws so that the bones fuse. The fusion may be promoted by first inserting bone-graft material, often obtained from elsewhere in the body.

Ankle fusion at Mayo Clinic may also be performed using minimally invasive arthroscopic surgery. With that method, surgeons use an arthroscope, a small camera inserted through an incision that allows the surgeon to view, diagnose and treat the joint.

After ankle fusion surgery, the screws and plates usually remain in the ankle after healing. After ankle fusion surgery, the ankle joint may have a smaller range of motion than before surgery. Other joints, if healthy, may be able to compensate for the loss of range of motion. Some patients walk so well after healing is complete that observers may not be able to tell which ankle was fused. The greater load on the other joints may eventually result in arthritis. Ankle fusion may allow for more stability and less pain than other ankle surgeries.

Ankle replacement surgery

Mayo Clinic orthopedic foot and ankle specialists conduct a comprehensive orthopedic evaluation to determine if ankle replacement is the most appropriate treatment for the patient. Because significant risks and possible complications may occur, specialists recommend ankle replacement only after a comprehensive evaluation. Patients who may benefit most from ankle replacement are those who also have another bad ankle or an injury or arthritis elsewhere in the foot or knee on the affected side. Patients who have reduced range of motion because of previous fusions below the ankle may be good candidates.

In ankle replacement surgery, a surgeon makes an incision in the front of the ankle and removes the damaged joint surfaces. The surfaces are replaced with plastic and metal devices called prostheses.

Ankle replacement may give the patient movement in the foot and a near-normal gait. After surgery, patients may walk and take part in low-impact activities such as golf. They should not, however, engage in such exercises as step aerobics or use an incline treadmill or stairstep machine. Artificial joints can wear or become loose, and may eventually need to be replaced. A replacement joint's life depends on how the joint is used.