Osteotomy for salvage of the arthritic ankle

Ankle arthrodesis continues to be the procedure of choice for ankle arthritis. Coester and colleagues showed that arthrodesis is a significant risk factor for development of arthritis in the ipsilateral hindfoot and forefoot, however. Total ankle arthroplasty has gained significant interest but is not yet ideally suited for younger active patients because of unacceptable failure rates and complications. Osteotomies can play an important role in re-establishing normal alignment and potentially decreasing the rate of progression of wear on the articular surfaces and decreasing pain, which may allow more time before arthrodesis or arthroplasty are needed. The success of total ankle arthroplasty depends largely on the alignment of the foot and ankle and osteotomies can be used in a staged manner as part of a reconstructive effort including total ankle arthroplasty. Supramalleolar osteotomies can be used to align the tibia; alternatively, osteotomies in the midfoot and hindfoot can be used to balance the foot and ankle making them suitable for arthroplasty in an individual who perhaps would not otherwise have that treatment option. Further studies will continue to clarify the role and indications for osteotomies for treatment of ankle arthritis.