Ankle Osteochondral Lesions

• May depend on the specific or associated underlying cause
• Pain – in the ankle joint if a cartilage injury is present, synovitis of the joint or impingement
• Swelling
• Recurrent instability
• Difficulty walking on uneven ground, difficulty playing sports
• Clicking or subluxation/dislocation of the peroneal tendons
• Catching within the joint

Symptoms may wax and wane, or worsen. If repetitive, there is risk of fracture, cartilage damage or injury to the peroneal tendons. Eventually ankle joint arthritis may ensue resulting in loss of articular or joint cartilage leading to progressive stiffness/pain/swelling.

Many are related to trauma, chronic instability of the ankle joint or recurrent ankle sprains. Other causes include repetitive micro trauma, avascular necrosis (loss of blood supply to the bone), congenital or spontaneous necrosis of the bone.

• Weight-bearing X-rays are required
• Long leg X-rays, CT scans or MRI scans may be required

• Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
• Footwear modification
  • lateral heel wedge
  • flared sole
• Activity modification
  • improve fitness and strength via non axial loading exercises e.g. cycling, swimming.
• Physiotherapy
  • strengthening of peroneal tendons
  • proprioception including wobble board and stretches
• Weight loss management
• External lace up ankle brace support or taping

Fixation for ankle syndesmosis

This technique is used to stabilise an ankle after injury. It can be used to repair a high ankle sprain, which damages the soft tissue structures between the tibia and fibula and causes these bones to separate. It can also be used to stabilise a fracture of the fibula. The TightRope system anchors the ends of the tibia and fibula together with a braided polyethylene cord, rather than with a rigid surgical screw, to restore the original position of the bones and to allow for proper healing.

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

• Infection: superficial wounds or deep infections
• Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
• Nerve damage: tingling, numbness or burning
• Ongoing pain
• Stiffness of the ankle joint
• General or anaesthetic risks including to the heart and lung
• Drug reactions/allergy
• Scarring or tethering of the skin
• Rerupture
• Calf weakness
• Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.