Ankle Arthritis Surgery: Ankle Exostectomy Surgery

Ankle Arthritis: Motion blocking bone spurs form on the front of the ankle joint. Dr. Neal Blitz

An ankle exostectomy is a surgery to remove bone spurs that develop on the front of the ankle joint.  Ankle bone spurs tend to form as a result of ankle arthritis.  The spurs can be large and painful.  Patients with ankle arthritis seeking surgery find that there are several surgical options depending on the severity of the problem.  

What Is Ankle Arthritis?

Ankle arthritis is a condition where the cartilage of the ankle joint deteriorates and motion becomes limited and painful.

  Progressive arthritis leads to bone cysts and bone spur formation.  The bone spurs typically form on the front of the ankle joint and can become quite large.  These bone spurs that form, develop on the outside (or periphery) of the joint, with the purpose of blocking motion.  The bone spurs are the bodys natural response to the underlying arthritic process.  Sometimes the bone spurs become so large that they fracture or break, becoming loose boney fragments. The bone spurs themselves may be painful if they are large, bang into adjacent bone spurs and/or associated with inflammatory tissue.  

What Are The Various Options To Treat Ankle Arthritis?

There are several options to treat ankle arthritis - nonsurgical and surgical.  Nonsurgical options include pain medication, anti-inflammatory medication, ankle braces, physical therapy and/or injections.  Ankle arthritis surgery options include procedures that maintain the ankle joint (joint salvage procedures) or procedures that remove the ankle joint (joint destructive procedures).

 In general, joint salvage procedures are for earlier stages of arthritis whereas joint destructive procedures are for end-stage arthritis.  

What Is Ankle Exostectomy?

A surgery to remove the bone spurs is called exostectomy.  The goal of ankle exostectomy is to remove the bone spur(s).  If the bone spurs themselves are painful then simply removing the bone spurs may alleviate discomfort,  Additionally, if the bone spurs develop so that they limit motion, removing the bone spurs may alleviate symptoms.


There are two methods to remove the bone spurs:

    1. Arthroscopic Ankle Exostectomy

    2. Open Ankle Exostectomy

Arthroscopic Ankle Exostectomy:   This type of ankle exostectomy involves the use of small/limited incisions to remove the bone spurs with the aid of cameras and bone shavers.  An advantage of this procedure is that it is generally considered minimally invasive, and other aspects of the ankle arthritis can be addressed - such as some bone spurs and/or scar tissue.  However, ankle arthroscopy is better indicated for mild to moderate ankle arthritis because more severe arthritis makes it technically difficult to access the joint arthroscopically.   

Open Ankle Exostectomy:   An open ankle exostectomy is a more traditional approach to remove the bone spurs by making an incision(s) on the front of the ankle.  Here direct visualization can be achieved and the bone spurs removed.  Because the exposure is wider, the bone spurs that may be difficult to remove with arthroscopy can be removed with an open technique.

 This approach is better suited for more advanced arthritis, or those bone spurs with end-stage ankle arthritis.

The Recovery After Ankle Exostectomy

The recovery for ankle exostectomy is considered rather quick in that patients are frequently allowed to walk on the operative extremity right after surgery. This is beneficial when considering other surgical interventions for ankle arthritis surgery, where recovery can be quite prolonged.  

The Upside And Downside Of Ankle Exostectomy

Ankle exostectomy is an effective method of removing bone spurs, and if the bone spurs or the motion they are blocking are responsible for the pain, then the procedure may be quite successful.   However, removing the bone spurs also frees up the ankle joint to move, and this can be problematic for an eroded ankle joint as this can cause painful motion.  The bone spurs may reform over time and something that should be considered.  While motion may improve initially after exostectomy, scar tissue may develop and further limit motion.  

Why Choose Ankle Exostectomy?

While exostectomy will not cure the underlying arthritis, it may remove the symptoms associated with the bone spurs and possibly improve motion.  It's best for milder cases of arthritis, and often used as an intermediary procedure should the arthritis progresses to end-stage.

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