The ankle joint plays a critical role in everyday movement, from walking to running and maintaining balance. When severe arthritis or injury damages this joint, it can lead to chronic pain, stiffness, and reduced mobility.

For some patients, an ankle replacement may provide a solution to restore function and quality of life.

This blog explores the anatomy of the ankle, and what you need to know about ankle replacement surgery.

Anatomy of the Ankle

The ankle is a complex hinge joint formed by three primary bones:

1. Tibia: The shinbone, which forms the inner part of the ankle.
2. Fibula: The smaller bone of the lower leg, which forms the outer part of the ankle.
3. Talus: A small bone that sits between the tibia and fibula above and the heel bone (calcaneus) below.

These bones are connected by ligaments that provide stability, while tendons facilitate movement.

The joint surface is covered with cartilage, a smooth tissue that allows for pain-free movement.

This intricate structure supports weight-bearing and enables flexion, extension, and slight rotational movements.

What Is an Ankle Replacement?

An ankle replacement, also known as total ankle arthroplasty, is a surgical procedure in which a damaged ankle joint is replaced with an artificial implant. This surgery aims to alleviate pain, improve mobility, and restore a functional range of motion.

The procedure involves removing the damaged portions of the tibia, fibula, and talus and replacing them with a prosthetic device designed to mimic the natural joint's anatomy and function.

Who Needs an Ankle Replacement?

Ankle replacement is typically recommended for individuals with:

• Severe ankle osteoarthritis that significantly impacts daily activities.
• Post-traumatic arthritis, resulting from a previous injury.
• Rheumatoid arthritis, which causes joint inflammation and destruction.
• Failed previous surgeries, such as unsuccessful ankle fusions or other interventions.

Ideal candidates are individuals who:

• Have relatively stable ligaments.
• Are not significantly overweight, as excess weight can strain the implant.
• Are older or less active, as high-impact activities can shorten the lifespan of the prosthetic device.

Who Is Not a Good Candidate for Ankle Replacement?

Ankle replacement may not be suitable for individuals with:

• Severe deformities or instability of the ankle.
• Advanced osteoporosis, which weakens the bones.
• Ongoing infections in or around the joint.
• A history of high-impact activities or jobs that require heavy manual labour.
• Neuropathy or loss of sensation in the foot and ankle.

In these cases, alternative treatments, such as ankle fusion, may be more appropriate. I always ensure that my patients are kept informed of all their options and risks so that they can make an informed decision.

What Is the Best Ankle Replacement Device?

There is no single "best" ankle replacement device, but the Prophecy Total Ankle Replacement (TAR) from Stryker has proven to be the best replacement I have used so far.  

This device includes some very helpful features, the most notable being the resection guides manufactured according to pre-operative standing CT scans – these scans include the foot, ankle and knee which gives highly accurate information of the whole of the lower limb.

This customisation makes the operation more predictable, accurate, and significantly reduces operating time, leading to better outcomes for patients.

Over the last 20 years I have used other ankle joint replacements like the  Hintegra Total Ankle Replacement TAR, the Mobility TAR and the Zenith TAR and there are other implants like the STAR ( Scandinavian TAR) and the Zimmer Trabecular Metal TAR on the market but due to the patient specific instruments and the most modern design the Prophecy TAR seems to be the best implant available. 

Components of an Ankle Replacement Device

An ankle replacement device typically consists of three main components:

1. Tibial Component: Replaces the lower end of the tibia.
2. Talus Component: Replaces the upper surface of the talus.
3. Polyethylene Spacer: A durable plastic insert that sits between the tibial and talus components, facilitating smooth movement and absorbing stress.

These components are usually made from biocompatible materials such as titanium, cobalt-chromium alloys, and polyethylene to ensure longevity and compatibility with the body.

The Process

1. Surgery: The procedure is performed under general or regional anaesthesia. The damaged joint surfaces are removed, and the prosthetic components are installed.
2. Postoperative Care: After surgery, your ankle will be placed in a splint or boot for 10-14 days to protect the ankle joint and allow initial healing.
3. Hospital Stay: Most patients stay in the hospital for 1-2 days, depending on their recovery and pain levels.
4. Weight-Bearing: Initially, you will use crutches or a walker to avoid putting weight on the operated ankle. Gradual weight-bearing begins normally 2 weeks after the operation and you will be allowed to gradually increase your weight bearing over a period of 2 to 4 weeks so that you are able to fully weight bearing about 4 to 6 weeks after the operation.
5. Physiotherapy: Rehabilitation exercises are crucial to restore strength, flexibility, and mobility. You should see an experienced physiotherapist as soon as you are allowed to start putting some weight through the operated leg (after 2 weeks) and you will learn how to walk partial weight bearing and work on the flexibility of your ankle joint replacement. It is important that you exercise and mobilise your ankle daily in order to achieve the best outcome.

How Long Will I Need to Be in the Hospital?

Following an ankle replacement, most patients stay in the hospital for 1-2 nights. During this time, your medical team will monitor your recovery, manage pain, and ensure there are no complications.

You’ll also receive instructions on caring for your surgical site and using assistive devices like crutches.

How Long After Surgery Can You Walk?

Most patients begin walking with the aid of crutches or a walker within 2-4 weeks post-surgery. However, full weight-bearing on the ankle may take 6-8 weeks, depending on individual healing.

I ensure that my patients are monitored closely over this period by an experienced physiotherapist, to ensure optimal recovery.

What Is the Recovery Time Following an Ankle Replacement?

Recovery time varies but typically follows this timeline:

• Weeks 1-2: Rest, elevation, and limited mobility with a splint or boot.
• Weeks 3-6: Gradual weight-bearing and the introduction of physiotherapy.
• Weeks 6-12: Start walking unaided and increase level of activities, continue physiotherapy.
• Months 3-6: Continued strengthening and mobility exercises; most patients return to normal daily activities.
• 1 Year: Full recovery, including improvements in pain relief and joint function.

What Are My Limitations Following an Ankle Replacement?

While ankle replacement can significantly improve quality of life, certain limitations should be expected:

• Avoid high-impact activities like running, jumping, or heavy lifting.
• Be cautious with activities that involve uneven terrain to prevent falls.
• Returning to sports and recreational activities; low-impact options like swimming or cycling are usually recommended.

Will I Need Rehab After My Ankle Replacement?

Yes, rehabilitation is a vital component of recovery. A physiotherapist will guide you through exercises to:

• Restore strength and flexibility.
• Improve balance and stability.
• Teach proper walking techniques to avoid strain on the new joint.

Rehabilitation typically lasts 3-6 months but may continue longer depending on your progress.

Conclusion

Ankle replacement is a sophisticated and highly specialised surgical procedure that offers significant pain relief and improved mobility for those suffering from severe ankle arthritis or other debilitating conditions.

Over the last 20 years the outcome of these procedures has improved considerably and being able to use custom made resection guides has made a huge difference to these operations resulting in much higher patient satisfaction rates. 

By understanding the process, recovery timeline, and potential limitations, patients can make informed decisions and set realistic expectations for their outcomes.

If you are suffering from ankle pain that could be caused by arthritis of the joint and you think that you might benefit from this treatment or if you have questions about your suitability for the procedure, schedule a consultation with me to discuss your options and develop a personalised treatment plan.

I will listen to your concerns, take a full history, examine your ankle and foot and if needed get some imaging to provide you with all the information necessary so that you make an informed decision of what will be the best treatment for you personally. 

Footballer’s Ankle - Anterior Impingement Syndrome

The name footballer's ankle is used because footballers are especially prone to developing this condition due to the amount of kicking that’s involved in the sport. However, if you participate in any sports that requires you to sprint, jump, and frequently change direction, you are at an increased risk of developing anterior ankle impingement. It is also a common in injury in basketball players, dancers and gymnasts.

This painful condition can decrease your mobility and limit your ankle range of movement; in severe cases, it can take you out of the game and require surgical intervention.

Types of Footballer’s Ankle

There are two types of footballer’s ankle:

Soft Tissue Impingement

Soft tissues including the ligaments and the joint capsule become pinched between the two bones of the ankle joint, the tibia and talus. 

Bony Impingement

The shin bone jars against the ankle bone, causing microdamage which the body tries to heal by producing extra bone growth. This bony lump can block movement and cause pain, and also trap the soft tissues. 

What Causes Footballer’s Ankle to Develop?

Footballer's ankle is caused by any activity that requires repetitive and forced plantarflexion and dorsiflexion in your ankle; in other words, pointing your foot down and it being forced up, like when you kick a ball or land in a jump.

If the tissues in the front of your ankle become stretched and damaged, scar tissue and inflammation occur. These thickened and damaged tissues can become pinched inside the ankle joint leading to pain and further inflammation.

As the condition continues, calcific deposits begin to form in the joint, and eventually these grow into bone spurs. A bone spur is a bony lump that blocks the natural movement of your ankle and also adds to the entrapment of the soft tissues during the upward movement of the ankle.

These bone spurs can eventually lead to damage of the talus bone – the bone at the bottom of your shin bone that articulates with the top of your foot bone.

Another very common cause of anterior ankle impingement is from spraining your ankle badly or repeatedly. This is because each time you do, your ligaments over stretch and become inflamed and weaker. These stretched ligaments cause problems in two ways – they catch inside the joint causing anterior impingement, and also, they no longer do their job of telling your brain how and when to move your ankle. This means you become less coordinated and makes you more susceptible to further ankle sprains.

What Are the Symptoms of Footballer’s Ankle?

No matter how your footballer’s ankle has developed, the most prevalent symptom is usually pain and persistent discomfort, and often a significant decrease in your range of motion.

Common symptoms of footballer’s ankle include:

• Pain on the front-outside (anterior) part of your ankle
• Pain pointing your toes
• Pain when jumping, running or squatting
• Swelling (especially after exercise)
• An audible clicking sound that occurs when you flex your ankle upward or downward.
• Reduced ankle movement
• Tenderness when you push into the front of your ankle joint.

Footballer’s ankle can become so painful that it may become difficult to not only perform the dynamic motions that are part of your sport but also basic movements and activities. If you suspect you have footballer's ankle, it's important to seek medical attention as soon as possible.

The severity of footballer’s ankle and the recommended plan to treat it will vary from person to person.

When Should You Seek Treatment?

As with any sports-related injury—and any foot or ankle injury in general—it’s important to take your symptoms seriously. Do not convince yourself that your symptoms will go away on their own. If left untreated, foot and ankle conditions can potentially worsen.

Seeking timely treatment for footballer’s ankle allows you to get relief from your symptoms and mitigates the risk of further complications.

Remember, the sooner you contact a foot and ankle specialist, the sooner you can get the treatment you need. Prompt treatment for footballer’s ankle improves your recovery journey and treatment outcome so you can heal fully and return to the sport or other physical activity that you enjoy.

How Is Footballer’s Ankle Diagnosed?  

Your doctor can diagnose ankle impingement by completing a physical examination and sending you for imaging tests. An MRI and ultrasound can offer images of soft tissue impingement and swelling, while X-rays and CT scans can reveal bone spurs.

Standing CTs can be particularly useful – all these images and scans can be arranged at most of the clinic sites that Martin works at.

How Is Footballer’s Ankle Treated?  

Treatment for footballer’s ankle will vary, as treatment options will be tailored to the severity level of your condition.

For some people with footballer’s ankle Physiotherapy rehabilitation is enough to settle your symptoms. Specific treatments and exercises will help strengthen your ankles, reduce your pain and inflammation and improve your balance and coordination.

Steroid injections might also be recommended to help reduce swelling and tissue inflammation which will in turn reduce the impingement of those tissues.

If you have a more severe and ongoing case of footballer’s ankle, you may need surgical intervention. Your surgeon can remove or repair inflamed or damaged tissue, fix structural issues, and remove bone spurs.

Arthroscopic ankle surgery is only indicated as a last resort if conservative management has been unsuccessful. It is a highly effective and very safe procedure with excellent outcomes.

How to Prevent Footballer’s Ankle

Prevention is always better than cure!

If you participate in any of the above sports, it is important that you train sensibly and take preventative measures to reduce the risk of developing footballer’s ankle.

Here are a few tips:

• Wear supportive shoes that fit you well.
• Incorporate ankle and lower limb strengthening into your routine.
• Yoga and Pilates can also be helpful as these activities involve improving your balance and stability.
• If necessary, use ankle braces or supports to give you extra stability and reduce the risk of sprains.        

If you have footballer’s ankle or any foot-related or ankle-related condition or injury that needs to be addressed please get in touch to book an appointment.

If you are experiencing ankle problems, it’s important to place your trust in an experienced and knowledgeable ankle specialist. Treating an acute or chronic ankle injury requires a specialised treatment plan that’s tailored to your specific needs. By prioritising your comfort, communicating openly and honestly, and sharing the precise steps you should take for a successful recovery, Mr Martin Klinke can resolve your ankle issues and help you regain your mobility.

Finding the Right “Ankle Specialist Near Me”

Have you typed “ankle specialist near me” or “ankle specialist in London” in your favourite search engine? If so, the names of quite a few London ankle surgeon specialists surely appeared in your search results.

Which ankle specialist in London should you turn to? If you need surgery, which London ankle surgeon should you consult? While there are many ankle specialists in London, we recommend that you place your trust in Mr Martin Klinke. He takes a caring and comprehensive approach to ankle injuries and ankle surgery, and his decades of experience and extensive expertise in the fields of Orthopaedics and Sports Medicine make him the “ankle specialist near me” you’ll be happy you chose. 

Meet Mr Martin Klinke

As one of London’s leading orthopaedic surgeons, Mr Klinke specialises in any and all problems that occur within your feet and ankles. These problems include, but are not limited to: ankle fractures, ankle joint impingement, ankle pain, ankle sprains, and ankle arthritis.

Mr Klinke attended medical school in Frankfurt before earning his master’s degree in Sports Medicine from the University of Nice in France. His post-graduate orthopaedic training was completed in Germany and France before he accepted a fellowship at the Royal National Orthopaedic in Stanmore, London.

Having the opportunity to work alongside Prof. Hinterman in Basle, Switzerland, gave Mr Klinke valuable insights into ankle pathologies and total ankle joint replacement procedures. In 2003, Mr Klinke was appointed as a Consultant Orthopaedic Surgeon at Guy’s and St Thomas Hospital Trust; the following year, he became a member of the esteemed London Foot and Ankle Centre.

Mr Klinke has been treating patients with acute injuries and chronic ankle problems since 2008, when he became a full-time private foot and ankle surgeon at London Bridge Hospital. He continues to serve as an Orthopaedic Foot and Ankle Surgeon who specialises in foot and ankle pathologies. Offering a full spectrum of foot and ankle care allows Mr Klinke to help patients of all ages, contribute to advancements in the fields of Orthopaedics and Sports Medicine, and actively participate in shaping the future of foot and ankle care.

Ankle Specialist in London: Why Choose Mr Klinke

Your feet and ankles are rather complex. Your feet, for example, contain a total of 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. It’s incredible how the feet and ankles work in tandem to offer you support, balance, and flexibility.

When you experience a foot injury, ankle injury, or when you develop a chronic condition that compromises the health of your feet, it’s important to seek care as soon as possible. The sooner your trusted London ankle surgeon can evaluate your feet and ankles and diagnose the problem, the sooner you can embark on your journey toward a successful recovery.

Allowing an ankle injury to go untreated increases the risk of long-term complications. Untreated injuries can exacerbate the current injury as well as increase your risk of developing secondary ankle issues that may require more extensive interventions. Mr Klinke can give you information about treating your injury as well as taking precautions to prevent future injuries.

As a respected and dependable ankle specialist in London, you can count on Mr Klinke to restore the stability and function of your ankles. If your injury or condition requires surgical intervention to provide the best possible outcome, rest assured that Mr Klinke is well-versed in reconstructive foot and ankle surgery, including ankle arthroscopy, minimally invasive Achilles tendon repair, bunion surgery, and operative reconstruction of foot deformities, just to name a few.

Mr Klinke’s background in Sports Medicine will benefit you if you have an acute foot or ankle injury, or if you are suffering from a painful and persistent overuse injury such as plantar fasciitis. His Sports Medicine training also allows him to confidently administer cutting-edge, proven treatments, including shock wave therapy.

Mr Klinke is such a distinguished London ankle surgeon that he is often asked to travel internationally in order to treat specific, complex, and rare foot and ankle conditions. The most dependable ankle specialist in London is a call away; Mr Klinke will do everything he can to help you return to sport and/or the active lifestyle you enjoyed before pain, swelling, or other symptoms set in and made you begin your search for “ankle specialist near me.”

Contact an Accomplished Ankle Specialist in London Today!

It will only take one video or telephone consultation with Mr Klinke for you to recognise that he is committed to giving you the personalised care you want and the compassion you deserve. He’s passionate about working closely with his patients to ensure that their needs are met and their goals for a full recovery are achieved.

As the only foot and ankle surgeon in London with qualifications in both Orthopaedics and Sports Medicine, Mr Klinke will explore the most suitable conservative options available to help you avoid surgery, but if surgery is necessary, you will be in good hands. The customised approach you’ll receive from Mr Klinke will make you feel confident that you chose him to care for your ankles.

Under his expert care, you will be well on your way to a recovery that restores your foot health and contributes to your overall well-being. Hopefully, you’ll even be inspired to tell others about your superior experience with this renowned ankle specialist in London who takes pride in his work and demonstrates a genuine and vested interest in each patient's journey toward optimal foot health. 

Do you suffer from plantar fasciitis heel pain and/or ankle pain? If so, you’re not alone.

According to Medscape, an estimated one million patients visit the doctor yearly because of plantar fasciitis. This chronic foot condition causes 10% of running injuries and comprises up to 15% of all foot-related issues needing professional treatment. Moreover, it’s estimated that 10% of the general population deals with plantar fasciitis.

The good news? Given plantar fasciitis’s prevalence, there’s been plenty of research and advancements in treatments to reduce pain and improve your quality of life.

The Symptoms And Causes Of Plantar Fasciitis Heel Pain

Plantar fasciitis is primarily known for causing chronic heel pain and is the most common cause of that same symptom. The condition occurs when a strain, swelling, or inflammation occurs in the thick tissue band travelling across the bottom of the feet and connecting the toes and heels. This band of tissue, or ligament, is called the plantar fascia.

The function of the plantar fascia is to absorb shock while walking, wherein small tears can result from stress and tension on the fascia.

If tearing and stretching persist, it causes inflammation and irritation. That said, in many instances of plantar fasciitis heel pain, the underlying cause is often unclear.

Symptoms of plantar fasciitis include stabbing pain near the heel at the bottom of your foot. Most often, any related stiffness and soreness are at their worst when you wake up. Additionally, extended periods of walking or standing can trigger pain and discomfort. Standing up after sitting for a long time can also lead to a flare-up of your plantar fasciitis symptoms.

Those suffering from plantar fasciitis heel pain can worsen their symptoms by wearing hard-heeled or ballerina/flat-soled shoes.

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(While plantar fasciitis ankle pain is less frequent than heel pain, it’s still a risk for those hampered by this chronic foot condition. Episodes of plantar fasciitis can irritate your nerves and radiate to your ankle, causing severe discomfort.)

What Are The Risk Factors Of Plantar Fasciitis?

Here’s a list of factors that leave you vulnerable to plantar fasciitis heel pain and ankle pain:

• People between 40 and 60 years old tend to suffer most from plantar fasciitis.

• Anybody who partakes in long-distance running, aerobic dance, or ballet dancing is likelier to face plantar fasciitis symptoms. These types of activities rely on heightened stress on the heel and plantar fascia.

• Atypical walking patterns, high arches, and flat feet impact weight distribution when you stand, placing additional strife on your plantar fascia.

• Carrying too much body weight creates excess plantar fascia stress.

• Teachers, servers, and factory workers tend to suffer from plantar fasciitis heel pain because of how much time they spend on their feet during the working day.

Can Plantar Fasciitis Cause Complications?

Plantar fasciitis can have a negative, cascading impact on your quality of life. Due to the chronic heel pain you might face, you are likelier to change how you walk. This compensation can lead to broader foot issues or cause damage to your back, hip, and knees.

Treating Your Plantar Fasciitis

Much of the time, plantar fasciitis symptoms disappear soon after you wake up and get moving. All the same, the pain can often become more chronic and impede your overall quality of life. Thus, even if symptoms are minor, it’s best to be proactive and receive treatments ASAP.

After receiving a diagnosis from a trusted foot and ankle specialist, you’ll be given a conservative treatment plan that includes:

• Performing daily calf muscle stretches
• Wearing supportive footwear with a cushioned heel raise
• Putting insoles into your shoes
• Reducing weight-bearing activities like standing and walking

Specific instances might call for you to tape your foot, take anti-inflammatory medication for a few days, apply ice, and use a night splint.

Provided symptoms don’t improve after more conservative treatments, ultrasound-guided cortisone injections or shockwave treatments are worth considering.

Long-suffering patients with overly rigid calf muscles might benefit from a minor operation. In this instance, the tight calf muscle gets released by a small incision, relieving plantar fascia stress.

Are you dealing with chronic plantar fasciitis heel pain (or ankle pain)? Then contact one of London’s leading orthopaedic surgeons specialising in ankle and foot problems, Martin Klinke, to receive effective, lasting guidance and treatments.

Many problems in the foot and ankle can be associated with problems “higher up” in the leg. In particular, the gastrocnemius muscle plays an important role and can be linked to many foot and ankle pathologies. The gastrocnemius muscle is the biggest muscle in the lower leg and together with the soleus muscle forms the Achilles tendon.

High heeled shoes and prolonged periods of sitting at a desk can be linked to reduced flexibility of the calf. Often a genetic predisposition is responsible for the reduced “dorsiflexion” of the ankle/foot which means one has not enough movement “upwards”. This tightness can lead to many common problems in particular Achilles tendinopathies, plantar fasciitis, forefoot overload, hallux valgus and hallux rigidus, stress fractures, metatarsalgia and sesamoiditis. A dedicated stretching regime is essential in order to improve the flexibility of the calf muscle. In a few cases this may not prove sufficient and if symptoms persist a minor operation can be performed either on its own or in association with other operations to eliminate the problem. This so-called “proximal gastroc release” is a very small operation where the “tight portion” of the gastrocnemius muscle (aponeurosis) is cut which then allows the muscle to stretch appropriately. The procedure is done as a day case and does not need any “protection” afterwards. Patients can walk unaided and after a few days of rest can resume most activities again.

Martin Klinke is a leading foot and ankle specialist and available for appointments at leading centres in London.