Orthopaedic Surgeon
Valgus Ankle Arthritis
The ankle cartilage can wear out more on the outside of the ankle leading to valgus which is the ankle equivalent of being “knock kneed”
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The valgus appearance can arise from both within the ankle joint and outside of the ankle joint. This deformity outside of the ankle joint can be in the tibia and or the foot. It is an important principle that all deformity needs to be corrected above/within and below the ankle joint.
This can mean that the problem can be corrected in one stage (most commonly) or two stages if the deformity is more severe and complex.
Relieve pain correct deformity and preserve movement.
Valgus ankle arthritis is associated with a range of problems both within and outside of the ankle
joint and the surgeon assesses these elements and can address all of the aspects either in one or
two stages depending on the individual patients' combination of problems.
Situations that can lead to valgus ankle arthritis:
Deformity at the knee
That is they can be knock kneed- if this is severe enough it can contribute to the ankle problem and needs to be corrected first. This can involve a knee replacement if it is arthritic or a corrective osteotomy.
Deformity in the tibia
Malunited tibial fractures can present late with ankle arthritis and the tibial deformity may need to be corrected. This can involve an osteotomy (cut of the bone) to straighten it and either a tibial nail or plating.
Deformity below the ankle in the foot
This is the most common scenario. Mild deformity can be corrected at the time of the ankle replacement. Your Surgeon will make a judgement about what deformities need to be corrected and discuss this with you prior to surgery.
Flat foot deformity
If Flexible then corrective bony and soft tissue procedures can be employed that preserve joints and movement.
If Rigid then bony surgery with fusion may be required. Sometimes rigid deformity is created by previous foot surgery that is malunited and over time this leads to arthritis.
Procedures that may be required:
Achilles lengthening
Tightening of the Achilles is often present with significant valgus ankle deformities and lengthening is required as part of the soft tissue balancing. This decision is made in theatre.
Heel Shift
This is done percutaneously and the calcaneus(heel bone ) is cut and shifted under the tibia to correct the hindfoot alignment
Flat foot correction
This can involve a whole suite of procedures including a heel shift and achilles lengthening- Lateral column lengthening and tendon transfers.
Deltoid Ligament Reconstruction
The deltoid ligament on the inside of the ankle is an important ligament stabiliser of the ankle. This ligament is quite strong but it can get progressively stretched out with valgus ankle arthritis and sometimes requires reconstruction as
part of the process. This involves using an allograft ligament (ligament from someone else) to tighten the ligament and restore the soft tissue integrity to the inside of the ankle joint.
Ankle replacement
Correction of the ankle arthritis is completed with the ankle replacement and this can be achieved accurately using the Prophecy planning and Patient Specific jigs.