Treatments of the Ankle

The tibia (shin bone) and the fibula are the bones of the lower leg. Pilon fractures are injuries that occur at the lower end of the tibia and involve the weightbearing surface of the ankle joint. The fibula also may be broken. These injuries were first described more than 100 years ago and remain one of the most challenging problems for orthopaedic surgeons to treat. Common causes of pilon fractures are falls from a height and car accidents. 

The goals of pilon fracture surgery are to restore alignment and stability and allow healing of the tibia and fibula at the ankle joint. Once the fractures are healed, your foot and ankle orthopaedic surgeon's goals are to restore movement and strength at the patient’s ankle. 

Posterior ankle endoscopy/arthroscopy is a technique used to look at and treat problems in the back of the ankle. 

First, it’s important to understand ankle anatomy. The ankle joint is the joint between the lower leg bones (tibia and fibula) and the ankle bone (talus). The joint below the ankle joint is called the subtalar joint; it lies between the ankle bone and the heel bone (calcaneus). The talus has a bony prominence in the back next to the flexor hallucis longus (FHL) tendon. This is the tendon that moves the big toe downward toward the floor.

The bony posterior prominence might be the cause of ankle pain in some people if it is large (called a trigonal process) or it is not completely fused with the talar bone (called an os trigonum).

The subtalar joint is located just below the ankle joint between the talus and the calcaneus (heel bone). The main job of the subtalar joint is to allow for side-to-side movement of the foot and ankle. This movement aids in walking, especially on uneven surfaces.

Parts of the ankleWhen there is a problem in the subtalar joint, the location of pain is described as being deep. The exact location may be hard to describe. Pain may be felt in the soft spot on the outside of the ankle or in a horseshoe distribution behind and below the ankle.

The subtalar joint is located just below the ankle joint between the talus and the calcaneus (heel bone). The main job of the subtalar joint is to allow for side-to-side movement of the foot and ankle. This movement aids in walking, especially on uneven surfaces.

When there is a problem in the subtalar joint, the location of pain is described as being deep. The exact location may be hard to describe. Pain may be felt in the soft spot on the outside of the ankle or in a horseshoe distribution behind and below the ankle.

The two bones in the lower leg are the tibia and the fibula. The point just above the ankle where these two bones meet is called the syndesmosis. While technically a joint, it does not function like most joints as there is very little motion between the two bones. Its main functions are to provide stability to the ankle joint and allow for motion of the joint.

The most common way the syndesmosis is hurt is from a twisting or rotational injury to the ankle. The ligaments that support the syndesmosis are needed to stabilize it, and it is these ligaments that are stretched or torn when this type of injury occurs. Ankle sprains can injure the syndesmosis. The ligaments also can be injured when the ankle is broken. High ankle sprains that are commonly seen in football players are injuries to the syndesmosis.

Surgery of the syndesmosis most often is needed after a traumatic disruption. The goal of surgery is to properly align and stabilize the joint so the ligaments can heal in the correct position.

A Syme amputation is an amputation done through the ankle joint. The foot is removed but the heel pad is saved so the patient can put weight on the leg without a prosthesis (artificial limb). The goals of a Syme amputation are to remove diseased tissue or a non-usable foot and create a functional, painless limb.

The talus bone makes up part of the ankle joint and the subtalar joint. The ankle joint allows for up-and-down motion and the subtalar joint supports side-to-side motion. A talar fracture is a break in the talus bone that often involves both of these important joints. 

The ankle and foot must be well-aligned for proper function. The goal of surgery is to realign the bone pieces and restore the normal bone shape. The surgery also will restore the function of the ankle and subtalar joints. This surgery should reduce the chances of developing arthritis or losing blood supply to the bone.

Total ankle replacement, also known as total ankle arthroplasty, is a surgical procedure that foot and ankle orthopaedic surgeons use to treat ankle arthritis. Arthritic changes may be a result of normal wear and tear due to aging or from an injury such as a broken ankle or dislocation. Arthritis eventually leads to loss of cartilage, pain, and/or deformity.

The goal of ankle replacement is to provide pain relief while preserving ankle motion so the patient has less pain and better function during activity.