Information
Ankle pain can be for many reasons – arthritis , tendon tears, impingement, loose bodies for example, but can also be from pain in the adjacent joints – the subtalar and talonavicular joints. Ankle instability is frequently seen after previous ligament injuries but can also be seen as a result of cartilage damage, loose bone fragments of tendon injuries.
Ankle arthritis is not as common as arthritis in the hip or knee and is most commonly seen after previous trauma or multiple sprains. In early stages this may respond to orthotic management, physiotherapy but occasionally an ankle arthroscopy will help to remove impinging osteophytes. In end stage ankle arthritis there are two potential operations – ankle replacement or an ankle fusion. Both can have excellent outcomes in terms of relief of pain and improved function. The decision as to which one is best for the patient depends on many factors including age, deformity, range of movement and radiological changes.
Arthritis in the other hindfoot joints (subtalar, talonavicular or calcaneocuboid) can only be surgically treated with an arthrodesis or fusion. This is an operation where a stiff painful joint is converted to a fusion and so there is usually only a small change in the movement. The operation generally means 6 weeks in a cast and six weeks in a boot. Often orthotic management or injections will be helpful.
Impingement in the ankle may be from bone spurs, loose fragments of bone or soft tissue impingement. If this does not respond to non-operative management or an injection then an ankle arthroscopy is often considered.
Ankle instability is generally seen following previous ankle sprains. If the ligaments do not heal properly then they can be lax, leading to instability and recurrent ankle sprains. There are several other pathologies following a bad ankle sprain that can also lead to symptoms such as peroneal tendon tears, osteochondral lesions, impingement. Recovery after a bad ankle sprain can take a year and physiotherapy is key. If symptoms do not resolve then an MRI is generally arranged. Instability can be addressed with a lateral ligament reconstruction (Brostrom) and an arthroscopy is often performed simultaneously.
Who can refer:
GPs
How to refer:
SCI gateway (Lauriston Buildings > Orthopaedics – Foot and Ankle)
Who to refer:
Criteria For Referral:
- Patients with known hindfoot osteoarthritis when symptoms are at a level where they would consider surgery
- Any patient with a pain or instability following an ankle sprain that has not responded to physiotherapy
Essential referral criteria:
- Details of non-operative management
- Activity level (SALTIN-GRIMBY PHYSICAL ACTIVITY LEVEL SCALE)
(SALTIN-GRIMBY PHYSICAL ACTIVITY LEVEL SCALE)
SALTIN-GRIMBY PHYSICAL ACTIVITY LEVEL SCALE Mar only one option:
1. Physically inactive (I): Being almost completely inactive, reading, watching television, watching movies, using computers or doing other sedentary activities, during leisure-time.
2. Some light physical activity (LPA): Being physically active for at least four hours/week as riding a bicycle or walking to work, walking with the family, gardening, fishing, table tennis, bowling etc.
3. Regular physical activity and training (moderate PA, MPA): Spending time on heavy gardening, running, swimming, playing tennis, badminton, calisthenics and similar activities, for at least 2 to 3 hours/week.
4. Regular hard physical training for competition sports (vigorous PA, VPA): Spending time in running, orienteering, skiing, swimming, soccer, etc. several times per week.
