Ankle Malunion: When and How to Perform Supramalleolar Osteotomy

Ankle osteoarthritis is usually posttraumatic, creating asymmetric damage on the ankle joint in approximately 80% of cases. The talus is susceptible to tilt to the damaged cartilage area, producing a supramalleolar deformity with localized ankle arthritis. Supramalleolar osteotomy is joint-preserving surgical treatment for patients with localized ankle arthritis. This procedure's objectives include improving intra-articular load distribution by overcorrecting the axis, slowing down or stopping the degeneration of the tibiotalar joint, and improving function. Preoperative planning is paramount. Varus deformity can be corrected with a medial opening-wedge osteotomy or with a lateral closing-wedge osteotomy. Medial closing-wedge supramalleolar osteotomy of the tibia is the primary procedure for valgus deformity. Sagittal deformities produce a greater change in the tibiotalar contact area than coronal deformities and should be addressed. Fibular osteotomy is always recommended. Progression of ankle osteoarthritis is not uncommon and complete pain relief is not the aim of this procedure.