Alternative to Ankle Fusion for Marathon Athlete

Physiotherapy in Vernon for Ankle

Q:  X-rays of my right ankle show arthritis just on one side of the joint. I'd really like to keep training for a marathon but the pain is starting to get to me. I don't think fusing the joint is such a good idea. Can something else be done to fix the problem?

A: Osteoarthritis that occurs as a result of a poorly aligned ankle is not uncommon. In most cases (70 to 80 per cent), trauma to the ankle is the original cause of the problem.

If conservative care doesn't help, then surgery is often advised. The two most commonly used operations include ankle joint fusion or total ankle replacement (TAR). But there are some patients who could benefit from surgery to realign the joint instead.

The surgeon may be able to balance the uneven joint space. The operation is called realignment surgery. Too much tension on the tendons can be lessened. Angles between bones in the ankle can be changed. And the bone can be lengthened or shortened.

Shear forces can be reduced and shifted to be equal across the joint. Any deformity in the midfoot, forefoot, or hindfoot may be reduced. If realignment surgery is not successful, then a fusion or TAR can still be done.

The realignment approach has made it possible for some patients to continue participating in sports activities. Running long distances, including marathons, has been done by patients who have had this operation.

Reference: Geert I. Pagenstert, MD, et al. Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis. In Clinical Orthopaedics and Related Research. September 2007. Vol. 462. Pp. 156-168.

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