Foot & Ankle
Ankle Arthritis
What is ankle arthritis?
Ankle arthritis is a painful condition that affects the ankle joint. In a healthy ankle, rubbery material called cartilage covers the bones and helps them to slide smoothly against each other. Ankle arthritis occurs when this layer of cartilage is damaged or breaks down and the bones in the ankle grind together.
What Causes Ankle Arthritis?
The most common cause of ankle arthritis is ‘wear and tear’ damage to the joint cartilage. This often occurs with age. A sudden or traumatic injury such as a broken bone or torn ligament can also cause the ankle joint to become arthritic. In some instances, an inflammatory, auto-immune disease (rheumatoid arthritis) can attack the lining of the body’s joints and cause ankle arthritis as a result.
A number of factors are known to contribute to ankle arthritis. These include:
- Being overweight
- Getting older
- Having a joint injury
- Undertaking activities which place extra stress on the ankle
Ankle Arthritis Symptoms
Symptoms of ankle arthritis include:
- A limited range of motion
- A sensation of grinding within the joint
- Difficulty walking, running or standing
- Stiffness in the ankle
- A sharp stabbing pain or dull ache
- Swelling
Diagnosing Ankle Arthritis
Your GP or Dr de Villiers can diagnose ankle arthritis. This is usually done through a blood test, x-ray, and sometimes an MRI scan.
Ankle Arthritis treatment
Non-surgical treatments are usually recommended for early stage ankle arthritis. These include; weight loss, activity modification, physiotherapy, anti-inflammatory medication, cortisone injections and joint supplements.
Surgery for Ankle Arthritis
If conservative treatments do not relieve your pain, Dr de Villiers may recommend surgery. Most surgeries for ankle arthritis aim to:
- Restore your quality of life
- Relieve pain
The most common types of surgery for ankle arthritis include:
- Ankle Arthroscopy: in early stages to remove scarred ligaments and impinging bony spurs.
- Ankle Fusion Surgery: in which the damaged part of the ankle is removed and prepared bony surfaces are fused to make one bone across ankle joint.
Ankle Arthroscopy
What is Ankle Arthroscopy?
Ankle arthroscopy is a minimally invasive form of surgery that is used to diagnose and treat problems in the ankle joint. During ankle arthroscopy, Dr de Villiers will make two or three small incisions into your ankle and insert a thin, metal tube. The tube holds a light source and a camera, as well as any small surgical instruments that may be required. During surgery, Dr Shaun de Villiers will remove your damaged joint surface and replace it with an artificial implant. This procedure requires admission to hospital, anaesthesia, major surgery, and rehabilitation.
Why Do I Need an Ankle Arthroscopy?
Dr de Villiers may recommend ankle arthroscopy if your ankle pain isn’t responding to non-surgical treatments. Ankle arthroscopy procedures can also help our surgeon to further investigate the exact source of your pain.
How Do I Prepare for an Ankle Arthroscopy?
Ankle arthroscopy is a minimally invasive (keyhole) procedure. At your consultation in our rooms, Dr de Villiers will talk to you about your specific situation and you will be given written information on how to best prepare for surgery.
During your consultation, he will ask you about any prescriptions, medications, or supplements that you’re currently taking. You may be asked to stop taking certain medicines, such as blood thinners or ibuprofen, before the procedure. You will probably also be told to stop eating a number of hours before surgery.
Recovery from Ankle Arthroscopy
Ankle Arthroscopy is usually performed as a day procedure, and most patients go home after a two- or three-hour recovery period.
Before your surgery, you will be given information about your recovery process. It’s a good idea to have someone at home to look after you on the first day as you may still feel the effects of your anaesthetic. You may also be asked to keep your ankle elevated and to use an ice pack for the first few days.
After an ankle arthroscopy, you will need to change your dressing. Either Dr de Villiers, or a member of our orthopaedic medical team will tell you when and how to do this, and how regularly. You will also be asked to attend a follow-up appointment two weeks after the procedure.
You will also be given an exercise routine to follow when you go home. This will help your ankle to recover. You might also need to see a physiotherapist until your ankle has regained a good range of motion.
Ankle Reconstruction
What is Ankle reconstruction?
Ankle reconstruction surgery involves reconstructing the ankle ligaments. This is usually achieved through retightening the lax ligaments and occasionally does need a tissue graft obtained from other ligaments and/or tendons from the foot or ankle or artificial ligaments.
Why do I need an ankle reconstruction?
Dr de Villiers will usually recommend an ankle reconstruction if all other non-surgical approaches have failed. Specifically, surgery may be required if your ankle has not responded to the following treatments tried for a prolonged period of time:
- Physiotherapy
- Immobilization with brace
What happens during an ankle reconstruction?
What happens during an ankle reconstruction?
- Arthroscopy (Key hole surgery)
- Ankle Ligament Reconstruction (Open surgery)
During an ankle arthroscopy procedure, Dr de Villiers will use a small camera called an arthroscope to look inside your ankle joint. He will then use thin instruments to remove any loose pieces of bone or cartilage, and free any ligaments that are caught in the joint.
The ankle reconstruction, is usually done via open surgery. Reconstruction involves retightening the torn ligament with stitches, or in some cases, actually rebuilding the damaged ligament by replacing it with a graft from other ligaments within the foot or ankle.
What happens after surgery?
After surgery you will need to keep your ankle immobilized. This is usually done through the use of a plaster cast or protective boot. It is important that you keep ankle immobilized for the time recommended by your surgeon as removing them too soon, you risk re-tearing the ligaments.
Rehabilitation from ankle reconstruction surgery involves time. The length of your recovery will depend upon the extent of your injury and the amount of surgery that you needed. Rehabilitation time can range from a few weeks to a few months.
You will also need to undertake physiotherapy exercises to help you restore strength to your ankle. Dr de Villiers will talk to you about this.
Joint Fusion Procedure
What is Joint Fusion Procedure?
Ankle Joint Fusion Procedure, also known as ankle arthrodesis, is a surgical procedure which aims to relieve pain and maintain or improve ankle function. It is most commonly used for patients with advanced ankle arthritis. During a Joint Fusion Procedure, the ankle bones are fused together. This eliminates movement in the joint and reduces arthritic pain.
Is a Joint Fusion procedure right for me?
Dr de Villiers will usually recommend a joint fusion if all other non-surgical approaches have failed. Surgery may be required if your ankle has not responded to treatments tried for a prolonged period of time.
What happens during a joint fusion procedure?
A number of different methods may be used; however, the main procedure of joint fusion is always the same. The worn ankle cartilage will be removed and the ankle bone surfaces are prepared to be fused together and held in place with metal hardware.
The procedure is done under anaesthetic. It may be done via a traditional “open surgery” method or with a less-invasive arthroscopic (keyhole) approach. A bone graft may be used to support the fusion. This graft may be taken locally or from the heel bone or just below the knee.
Recovery from a joint fusion procedure
Your recovery time will depend on a number of variables, and our surgeon will talk to you about what to expect when you attend your consultation in our rooms.
Typically, Dr de Villiers will recommend not bearing weight on your ankle for at least six to eight weeks. Most patients find this time difficult, and typically rely on crutches, walkers, wheelchairs or knee scooters to move around.
Make sure that you prepare your home prior to surgery. This may involve adding ramps instead of stairs, or moving your bed to the ground level. You might also need aids such as commodes, railings or shower chairs. It’s also a good idea to have someone at home with you to help you with basic tasks like cooking or getting to the shops.
Any non-absorbable stitches are usually removed 10 to 14 days after surgery. After six to eight weeks your ankle will probably be strong enough to use a walking boot. After around 12-16 weeks you will probably be ready to walk without a boot, and begin your transition back to more vigorous activities.