Ankle pain and Arthroscopy

Ankle Pain:
 As a brief introduction,: The Ankle Joint (Talocrural Joint) is made up of 3 bones.  The Tibia and Fibula make up the lower leg and these bones are attached to the Talus by a series of ligaments.  Tendons are found all around the ankle joint and cause the foot to go up and down.  This is the action of the ankle joint: up (dorsiflexion), and down (plantarflexion). The up and down motion is what we mean when we say ankle pain.  There may also be pain with straight axial pressure, one may experience a "giving away" type feeling while standing or walking.

 
The ankle joint rarely sees arthritic changes from wear and tear like the knees and hips do.  Most often ankle arthritis will be a result of some traumatic injury remotely or acutely.  Arthritis is when the cartilage wears away and there is bone on bone.  Along with arthritis comes inflammation, and excess bone growth (bone spurs). 

Ankle fractures and ankle sprains are some of the most common causes of ankle pain and later, arthritis.  Ankle sprains (partial or complete), may have residual pain even months after the injury.  When a ligament is torn, there will be some bleeding into the joint which will later turn into scar tissue and usually have a chronic inflammatory component to it.  Often cortisone injections will alleviate some of the pain associated with inflammation and may help to break up some of the scar tissue.  If several injections have not provided adequate relief of symptoms, an MRI may be indicated to look for more significant causes of ankle pain.
OCD lesions (Osteochondral Defects) may be seen.  These are local areas of cartilage damage or arthritis.     

Osteochondral defects will often present with significant pain and disability.  Occasionally immobilization and rest will provide some relief of the symptoms associated with this pathology.  Often, surgical intervention will be needed to provide long lasting pain relief.  Generally the size of the lesion is predictive of how well the surgery will help to alleviate the pain.  The larger the lesion, the less effective the surgery.  An MRI will often give some idea of the size of the lesion but it may be larger in reality once the joint is visualized arthroscopically (microscopic camera that is inserted into the joint).

Lesions less than 10-12mm in diameter will usually do quite well after arthroscopic surgery.  You may be told to rest for a week or two after this surgery (no weight bearing).  For larger lesions, the surgery is less predictable and requires a longer period of rest (2-4 weeks non weight bearing).  During the surgery, the loose cartilage is debrided and small drill holes are placed in the bone beneath the cartilage.  This stimulates the body to produce fibrocartilage, which is similar to normal cartilage (hyaline cartilage).