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Orthopedics · Foot and ankle

Ankle osteoarthritis

Does your ankle joint hurt with every step, stiffen and swell? Often it is worn cartilage, most commonly after an earlier injury. HR Clinic offers cartilage treatment, ankle joint replacement or fusion of the joint, arthrodesis. If everything is in order, the procedure can take place as soon as within a week of the consultation.

Book an orthopedic consultation Surgical options
  • No referral from a GP needed
  • Operated by Prof. MUDr. Radek Hart

Procedure under general or regional anesthesia

1 weekthe procedure can be this fast
most common cause
injuryfracture or repeated ankle sprains
until the procedure
1 weekfrom the consultation, if everything is in order
everyday activities
3–4 monthsafter surgery in most cases
full recovery
4–9 monthsdepending on the findings and the extent of the procedure

When surgery is considered

Pain with every step and a stiff ankle joint

The ends of the bones in the ankle joint are covered by smooth cartilage on which the bones glide during movement. In osteoarthritis the cartilage gradually thins and breaks down, the space between the bones narrows and bone spurs grow at the edges of the joint. The ankle joint wears out less often than the knee or hip, most often after an injury.

  1. Pain when walking and under load

    The ankle joint hurts with every step and longer walking is difficult. The pain gets worse after exertion, often also in the morning or after prolonged sitting or rest.

  2. Stiffness, swelling and crackling

    The joint moves less easily, swells after load and may crackle. Walking becomes unsteady and the muscles around the ankle joint weaken. In an advanced stage the joint may become deformed.

  3. Often after an injury

    An ankle fracture or repeated sprains damage the cartilage. An injured joint has about a seven times higher risk of osteoarthritis than an uninjured one, even if the injury was treated properly. Osteoarthritis can appear even many years after the injury. An ankle that keeps giving way is described on the page Unstable ankle.

  4. Other causes

    Rheumatoid arthritis and other joint inflammation, diabetes, gout, excess weight or long-term overloading of the ankle joint.

Diagram of the right ankle joint seen from the front with healthy cartilage: the tibia and talus are covered by smooth, continuous cartilage and the joint space between the bones is preserved Healthy cartilage tibia talus heel bone fibula smooth, continuous cartilage Diagram of the right ankle joint seen from the front with osteoarthritis: the cartilage is thinned and largely missing, the joint space has narrowed, bone rubs on bone and a bone spur has grown at the edge of the joint Worn cartilage tibia talus heel bone 1 2 1 2 cartilage gone, bone on bone bone spur at the joint edge
  • outline of the foot
  • bones
  • joint cartilage
Simplified diagram of the right ankle joint seen from the front, not an actual image.

When to operate

When surgery is appropriate

Surgery is considered when ankle pain limits everyday life. The doctor decides at the consultation whether and when to operate.

Symptoms

Pain limits everyday life

When walking, at work and when sleeping.

  • The ankle joint hurts with every step and longer walking is difficult
  • Pain limits walking, sleep and everyday activities

Findings

Symptoms decide, not the image

The image alone does not decide on surgery.

  • Some people have major changes on the image and little pain, others the reverse
  • The doctor examines the ankle joint and gait and assesses the weight-bearing X-ray

Joint

Stiff or deformed ankle joint

In an advanced stage of osteoarthritis.

  • The cartilage disappears and bone rubs on bone
  • The joint moves less easily, swells and may become deformed

Not sure whether surgery is for you? The examination will tell; if you have diabetes, rather come earlier. Book a consultation

Surgical options

Preserve, replace or fuse the joint?

The choice of operation depends on how much of the joint the osteoarthritis has affected, the alignment of the foot and how mobile the joint still is, as well as on your age, health and activity demands. The decision is always individual and we will discuss it at the consultation.

The joint stays

Cartilage treatment

When the cartilage is damaged in only part of the joint.

  • The damaged area is treated and your own joint is preserved, with its movement
  • More suitable for early to moderately advanced osteoarthritis and in younger, active people
  • Which approach suits your joint is shown by the examination and images

Movement stays

Ankle joint replacement

When the cartilage is destroyed in a large part of the joint.

  • The damaged joint surfaces are removed and replaced with metal surfaces with a plastic insert
  • It relieves pain and preserves part of the movement, so the neighboring joints are not overloaded as much
  • More suitable for people who do not want to return to demanding sports
  • Over time it may loosen or wear; it can then be replaced

Pain goes, and so does movement

Arthrodesis of the ankle and hindfoot

Fusion of a joint that is stiff, deformed, or in active people.

  • The remaining cartilage is removed and the bones are secured with screws, possibly a plate or nail, until they fuse into one
  • A painful stiff joint becomes a stiff joint that does not hurt
  • Hindfoot: with osteoarthritis of the joints below the ankle joint, these joints are fused; the foot then tilts sideways less easily, for example on uneven ground
  • The neighboring joints carry more load and over the years osteoarthritis may also appear in them

Hindfoot fusion is also used for flatfoot in adults. More on the page Flatfoot

How the procedure works

From booking to going home

Before surgery the ankle joint needs to be examined thoroughly and the operation planned. The most important is a weight-bearing X-ray; CT or MRI is added as needed. The doctor will explain which procedure suits you based on the examination and images.

  1. Booking

    Online or by phone. A referral from a GP is not required.

    online or by phone

  2. Consultation and examination

    Prof. Hart examines the ankle joint and gait and assesses the images.

    diagnosis and treatment plan

  3. Procedure

    Under general or regional anesthesia; the anesthesiologist recommends the type. After the operation a cast protects the ankle joint.

    date according to the treatment plan

  4. Going home

    On crutches, with the leg raised as high as possible. You must not drive yourself.

    check-ups and physiotherapy

Recovery and physiotherapy

Recovery takes months

In most cases surgery relieves the pain and makes everyday activities easier. Most people return to them within 3 to 4 months; full recovery takes 4 to 9 months depending on the findings and the extent of the procedure. Mild swelling may last up to a year. If needed, we follow up with physiotherapy right at the clinic.

Room of the short-stay ward at HR Clinic

  1. First 2 weeks: leg up

    Keep the leg above heart level as much as possible so the swelling goes down. Keep the cast dry. The stitches are removed at the check-up after about 2 weeks.

  2. After joint replacement

    At first no weight is put on the foot; later, in the cast, weight is added gradually. You usually start walking on your own within 3 months, most people return to normal shoes within 3 months, and to undemanding sports after about 6 months.

  3. After arthrodesis

    The bones take about 3 months to fuse. A cast protects the foot the whole time and loading is increased gradually; at first no weight is put on the foot at all. A follow-up image confirms the fusion.

  4. Work and smoking

    You can return to seated work after about 4 weeks if you can keep your leg raised; physically demanding work may have to wait up to six months. Smoking slows bone healing and raises the risk that the bones will not fuse. Stop smoking before the operation and do not smoke until the bones have healed.

Prof. MUDr. Radek Hart, Ph.D., FRCS, MHA

Who operates

Prof. MUDr. Radek Hart, Ph.D., FRCS, MHA

Orthopedic surgeon and trauma specialist of the musculoskeletal system, head physician of HR Clinic. At a clinic in Vienna he is head of the foot outpatient clinic. He sees patients in Znojmo and Vienna; after a consultation in Vienna the procedure can be performed in Znojmo.

More about Prof. Hart Professional website ortho-hart.at

Price We will tell you the price of the procedure at the consultation, depending on the findings and the extent of the procedure.

Common questions

What patients ask most often

Related articles

Achilles tendon pain: when to pay attention and how to treat it How it works at HR Clinic

Other foot and ankle problems

Unstable ankle Flatfoot Achilles tendon Bunion and forefoot
Is joint replacement or arthrodesis better?

Both can relieve pain well. Replacement preserves part of the movement and puts less strain on neighboring joints, but it suits mainly people who do not want to return to demanding sports. Arthrodesis is more suitable for active people and for an ankle joint that is already almost immobile or markedly deformed. The doctor will recommend what is better for you based on the examination.

Will I limp after arthrodesis?

After a successful arthrodesis most people walk without limping, ride a bike and return to normal activities because the ankle joint stops hurting. The up-and-down movement is partly taken over by the neighboring joints of the foot, so on level ground you can walk in shoes without major problems.

How long does an ankle replacement last?

It depends mainly on how demanding the loads you put on the joint are. Ankle replacements do not yet have as long a proven lifespan as knee replacements. Over time they may loosen or wear; the replacement can then be exchanged or the joint fused.

What examinations are needed before the operation?

The most important is a weight-bearing X-ray; CT or MRI is added as needed. The doctor will explain which procedure suits you based on the examination and images.

How long will I stay at the clinic?

The stay at the clinic lasts 24 hours at most. If you need longer care after a larger operation, the clinic will arrange follow-up rehabilitation care at the Dačice Rehabilitation Institute, covered by public health insurance.

Will the operation hurt?

You feel nothing during the procedure. Operations on the foot and ankle joint are often painful afterward; medication relieves the pain, and keeping the leg raised helps too.

Do I need a referral from my GP?

No. It is enough to book online or by phone.

Booking

Book an orthopedic consultation

Online or by phone, at the clinic in Znojmo. A referral from a GP is not required.

Book a consultation
Book a consultation