ATOS – Your specialist for foot and ankle diseases in Germany

Our ATOS experts offer top-quality medicine in many different areas in our clinics, including foot surgery and ankle surgery. The foot consists of a complex interplay of bones, ligaments and muscles. Generally it is divided into the tarsus, metatarsus and toes. The ankle connects the foot to the tibia and fibula. It is divided into the upper and lower ankle joint. It consists of bone on the one hand and variety of ligaments on the other. Due to this structure, the ankle is very prone to injury. The most common is a tear of one or more of the inner or outer bands.

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Our ATOS experts are your contact for foot problems.

The foot is one of the most important supporting organs in human beings. If its functionality is limited, walking and standing will be difficult and even impossible without tools. The same applies to the ankle joint. For this reason it is important to treatment by competent expert hands if you experience complaints. Our ATOS specialists have many years of experience in dealing with diseases and injuries of the foot. These include malpositions such as hallux valgus and age-related osteoarthritis such as hallux rigidus. We can also treat ankle osteoarthritis or an Achilles tendon injury professionally. Even seemingly minor problems such as heel spurs are part of our expertise.

In the event that you need surgery on your foot or ankle, our foot surgery/ankle surgery techniques meet the highest standards. We see a positive recovery course as a result of close cooperation between patient and doctor and will make all processes as transparent as possible in your interest. We therefore cooperate closely with your attending physician, orthopaedic technicians and health insurance companies. With state-of-the-art technology and innovative treatment methods, we can also support you in regaining a pain-free life – in various ATOS Clinics in Germany.

Find out more about foot and ankle surgery

Foot surgery is possible under both general anesthesia and partial anesthesia; a range of anesthesia procedures is available in our private clinics for this purpose.
In most cases, you can place weight on your foot on the first day after surgery. In order for this to be possible, we will provide you with a special therapeutic shoe that enables you to stay mobile.
For certain indications it is possible and sensible for both feet to be operated on simultaneously. Your doctor will advise you and weigh the pros and cons with you.
Common problems of the feet include hallux valgus and claw toes. The most important question our patients have is often whether the complaints can return after an operation: We can reassure you here – provided that you wear comfortable and reasonably fitting shoes.
Of course you need responsive feet to drive a car. Please be aware that as a rule, you cannot drive for six weeks after a foot operation.

Our treatments in detail

Achilles tendon tear

The vulnerability of the hero Achilles, whom we are all familiar with from Greek mythology, can also become your weak spot. The Achilles tendon is the strongest tendon in the human body and can actually stand up to very heavy loads. But it nevertheless gets injured.

Definition
The Achilles tendon is the strongest tendon in the human body and can actually bear very heavy loads up to 800 kilogrammes. But slight injuries nevertheless occur. Achilles tendon injuries initially only cause pinching, but if left untreated can lead to painful inflammation and, in the worst case, an Achilles tendon rupture.

It consists of several tendon bundles, is 10-12 cm long, connects the heel bone (calcaneus) with the three-headed calf muscle (muscle triceps surae) at the rear foot and transmits force to the foot. The Achilles tendon allows for powerful lowering of the foot and is thus crucial for the entire gait pattern with normal pushing and rolling of the foot.

Symptoms
The onset of pain on the Achilles tendon or heel is a protracted and persistent symptom. The symptoms can be caused by external injuries such as bruises or contusions, but also by inflammatory processes. In most cases, patients initially complain of pain in the area just above the heel bone, which disappears again when relaxed. Without treatment, Achilles tendonitis may develop. Common Achilles tendon disorders include Achilles tendon pain syndrome (Achillodynia), tenosynovitis (parathyroid), Achilles tendon necrosis, Haglund deformity and Achilles tendon tear. If the Achilles tendon is torn, very typical symptoms appear. Patients report a whip-like bang with great pain over the heel. Walking becomes difficult, and it is no longer possible to walk on your toes.

Diagnosis
The typical examination for suspected Achilles tendon rupture is the so-called Thompson test. The patient lies prone on the table with his feet hanging over the edge. The doctor then compresses the calf muscles of the affected leg. Normally, the foot would stretch towards the sole. With an Achilles tendon tear, the foot does not move. Imaging procedures such as ultrasound and X-ray ensure the diagnosis.

Conservative treatment
In conservative treatment of this Achilles tendon injury, the foot is immobilised by a cast, orthosis or special shoe and healing supported by physical and medical measures.

Surgical treatment
Surgical Achilles tendon tears are mostly minimally invasive in our ATOS Clinics. The torn ends are sewn or glued together or the torn tendon is reconstructed or reinforced with the body’s own tissue. General anesthesia is not absolutely necessary because the surgery can also be performed with regional or local anesthesia.

Rehabilitation – Time and methodology
Intensive follow-up treatment is necessary after conservative as well as surgical therapy. The tendon is increasingly burdened in physiotherapy. Sports activities are usually possible 3-4 months after the Achilles tendon rupture.

Heel spurs

Heel spurs, medically referred to as plantar fasciitis, are a bone outgrowth on the heel bone. At an advanced stage, it can be very painful and plagues every tenth person in Germany. It is caused by bone deposits after overloading the foot.

Definition
A heel spur can occur in two forms: the upper (cranial) variant forms above the heel bone at the base of the Achilles tendon. The lower (plantar) variant arises below the heel bone in the base of the plantar fascia. Causes of the lower heel spur include pressure and/or tensile loads on the heel bone by overloading the connective tissue (fascia), which attaches to the heel bone and can ossify. Obesity, wearing inappropriate footwear and standing activities promote the formation of plantar fasciitis.

The heels carry the entire body weight with each step after setting the foot down; the load is a multiple of the body weight when running or carrying loads. Over the long term, small tears develop in the plantar fascia, which the body tries to repair by lime deposits and which form the heel spur.

Risk groups for the formation of a plantar fasciitis are overweight men and women in the middle age. But also people who have to stand a lot for work and people with uncorrected malpositions of the foot (flatfoot or splayfoot) or a cavus foot have an increased risk of developing heel spurs.

Symptoms
In the early stages, the heel spur causes no to a few complaints and is often discovered accidentally in X-rays. With increasing inflammation in the surrounding tissue (plantar fascia) the bone growth increases. The severe pain always correlates with the inflammatory response of the plantar fascia and not necessarily with the size of the bony heel spurs.

Typical symptoms include stinging pain in the heel or sole of the foot, which increase under stress and pressure pain. While standing is extremely painful, the pain subsides as soon as the foot is relieved. The first step in the morning after getting up is especially painful with heel spurs. Walking on hard surfaces can also be very uncomfortable.

Diagnosis
The doctor palpates the usually painfully shortened plantar fascia and the bone outgrowth, whereby the patient usually reacts with the typical pressure pain. An X-ray image often provides visible clarity. In some cases MRI (Magnetic Resonance Imaging) may also support a heel spur diagnosis. In order to rule out further causes such as gout or rheumatism, recommended blood tests are carried out at ATOS Clinics.

Conservative treatment
Plantar fasciitis treatment is basically conservative at first. The most effective treatment is special stretching exercises which physiotherapists can demonstrate. A special insert is also created, which is based on a computer-aided foot pressure measurement, which cushions the entire plantar fascia.

If these measures do not adequately relieve the symptoms, the inflammatory response is combated with locally effective injections by our heel spur specialists with enriched growth factors (ACP) or a specific hyaluronic acid. Local cortisone injections or injections of botulinum toxin (botox) can also relieve symptoms.

Surgical treatment
Conservative therapies can usually only alleviate the symptoms, and the permanent elimination of the cause is only possible with heel spur surgery. At ATOS Clinics the required interventions are part of the standard repertoire. Severe inflammatory reactions of the tissue can in particular lead to a tear of the plantar fascia. In such cases, minimally invasive heel spur surgery will remove the inflamed tissue for lasting relief. The heel spur is removed in a gentle operation.

Rehabilitation – Time and methodology
The patient can put weight on the operated foot and heel immediately after the procedure. Only partial weight should be put on the foot in the first two to three weeks so as not to prevent the wound healing. The patient is allowed to place full weight on the foot immediately after the wound has healed.

Hallux rigidus

Hallux rigidus is the medical name for the stiffening of the big toe. It is caused by wear (osteoarthritis) in the metatarsophalangeal joint and is associated with great pain. New surgical techniques at ATOS Clinics can prevent the joint from further stiffening and avoid the need for a fusion operation.

Definition
Hallux rigidus means “stiff big toe”. The big toe joint has to be able to withstand a multiple of body weight during exercise and especially during acceleration. The term refers to joint wear (arthrosis) in the big toe base joint, whereby usually the upper joint portion is affected first. The big toe joint swells, becomes painful and rolling of the foot is increasingly limited. As a result, bony prominences arise at the top and sides of the big toe. In addition to problems when rolling the foot while walking, there are often pressure problems in the shoe. Mobility is continuously restricted.

Symptoms
Due to the inflammation, the metatarsophalangeal joint is reddened and sensitive to pressure. Shoes increasingly begin to press on the area. At first, the big toe can still be bent well, but stretching becomes increasingly painful. As a reaction, movement is often restricted, which eventually leads to a fusion of the metatarsophalangeal joint due to lack of exercise. The onset of osteoarthritis of the big toe joint triggers complications due to improper stress. The outer edge of the foot and the four remaining toes are more heavily loaded. The protective posture of the foot can lead to overloading in the knee and hip.

Diagnosis
An X-ray shows changes in the metatarsophalangeal joint as narrowing of the joint space due to cartilage wear, usually also due to an altered bone pattern or spine-like spur formations.

Conservative treatment
In the initial stage, conservative measures can be used to improve things. Inserts (“rigidity cushions”) or a shoe modification (sole stiffening with set-back joint roll), anti-inflammatory pain medications, injections with hyaluronic acid or cortisone and physiotherapy can be used here.

Shoe inserts
A special carbon insert for the shoes leads to a reduced load on the big toe joint and is helpful in early stages. A joint roll in the front shoe plus stiffening of the shoe sole can also be successful. This relieves the big toe joint when rolling the foot. This is accompanied by special exercise therapy.

The insoles are made according to a computer-aided foot pressure measurement (pedography). From the data collected in this way, an individual insert is created from a special foam block in a CAD process and then covered with a high-quality leather.

Pain relief
The pain can be alleviated by different medicines. Direct injection of a special high molecular weight hyaluronic acid, a natural component of the cartilage, can stop the cartilage wear and improve the pain situation. An alternative is the application of growth factors derived from the patient’s own blood (Autologous Therapy/ACP – Autologous Conditioned Plasma). In addition to conventional painkillers, various homeopathic medicines have the reputation of relieving particularly arthritic pain.

Surgical treatment
If conservative treatment options do not improve the hallux rigidus, surgical treatment should be considered. New surgical techniques used in ATOS Clinics can restore mobility and permanently put an end to pain. Which hallux-rigidus operation method is suitable is decided on the basis of an individual diagnosis and not least the needs and living habits of the patient. Here is a selection of common methods:

Dorsal wedge resection (cheilectomy)
Dorsal wedge resection removes the inflamed mucosa and newly formed bone. This results in a significant reduction in pain and improved mobility. At the same time, the remaining articular cartilage can be stabilised and the formation of a replacement cartilage stimulated.
Osteotomy
In early stages of osteoarthritis, osteotomy can be used to achieve position-altering, joint-preserving bone correction that improves mobility and reduces pain. The flexion deformity of the big toe, which prevents rolling of the foot is corrected here – including simultaneous bone smoothing and removal of the inflamed mucosa. The original joint is preserved in its function here as well.
Stabilisation (arthrodesis)
In advanced cases of big toe joint osteoarthritis, stabilisation of the big toe joint is sensible. This is particularly useful in cases in which an almost complete and very painful stiffening of the joint has occurred. By stabilising the metatarsophalangeal joint (arthrodesis), pain-free and powerful rolling of the foot is possible again. The disturbed metatarsophalangeal joint is blocked here, which leads to permanent freedom from complaints.
Artificial joint (endoprosthesis)
As an alternative to the stabilisation operation, the use of an artificial joint (endoprosthesis) is also possible in advanced stages. This ensures the mobility of the big toe joint. The prosthesis is made of a special metal alloy coated with a titanium plasma spray to ensure rapid prosthesis integration. Fixation with bone cement is not necessary.

Rehabilitation – Time and methodology
The post-treatment depends on the respective surgical technique. The patient wears dress shoes with a flexible sole until the would has healed. Immediately after successful wound healing, it is possible to wear comfortable shoes again. Forearm crutches are initially recommended with the joint-fusion therapy to relieve loading. Full loading with a therapeutic shoe should take place for around 4-6 weeks.

Hallux valgus

Hallux valgus, or big toe ball, is one of the most common foot deformities. Women are affected ten times more often than men. The big toe shifts here to the middle toe, creating an outer bulge on the toe attachment.

Definition
In a healthy foot, all the toe bones are straight. With hallux valgus, on the other hand, the metatarsophalangeal joint of the big toe pushes outward and becomes visible as a more or less pronounced bulge, with the toe itself turning inwards.

Hallux valgus almost always arises on the basis of a genetic predisposition – so the deformation is inherited. In most cases, external factors contribute to its formation. These include, for example, wearing high-heeled shoes, footwear that is too tight or connective tissue weakness. But excessive weight, frequent standing or rheumatism are also among the risk factors.

The malposition of the metatarsophalangeal joint leads to ongoing cartilage wear and thus to arthritis, which increasingly causes pain in the joint. It is therefore advisable not to wait to go to the doctor until the impairments and pain are so great that you cannot help it, and the joint is most likely already badly damaged.

Symptoms
The first signs of hallux valgus are forefoot widening, pain in the middle toes and increased formation of calluses on the underside of the foot. Weals or corns may also arise. When the shift of the big toe to the middle toes begins, an outer curvature forms. This is not just a cosmetic problem. The longer the malposition persists and the more pronounced it is, the more the natural functions of the foot are impaired. The ball is often red and swollen, inflammation is possible. You should consult a specialist at the latest when there is pain in the toes.

Diagnosis
The typical deformation of the big toe ball is usually clearly recognisable and can be felt clearly by the doctor. An experienced orthopaedist can recognise the deformation in the examination and also see comorbidities, such as a kinked flat foot, claw toes or adjacent wear disorders of the ankles. The analysis of the concomitant problems of hallux valgus is essential as the foot functions as a biomechanical unit. Changes in one place usually have an impact on the overall system. The X-ray image is taken while standing with weight on the foot. This clearly shows the true extent of the deformity.

It also clearly shows whether there is a change in the great toe joint and how strong the axial misalignment is. The possible misallocation of the pressure load on the sole of the foot is measured by a computer-assisted foot pressure analysis (pedography). The result is included in the planning of the surgery.

Conservative treatment
The treatment of hallux valgus depends on the progress of the malposition. As long as the malposition is flexible, i.e. the big toe can still be moved into the original position, non-surgical treatments can be used. With fixed malpositions or severe pain and bruises, surgical therapies can be considered.

Surgical treatment
More than 100 different surgical techniques have been developed for the surgical therapy of hallux valgus. There are purely soft-tissue procedures without correction of the bone as well as combined bone and soft-tissue operations. The selection of the method can only be determined after a thorough examination by the specialists in our practices at ATOS Clinics. Here is a selection of our favourite methods:

Reverdin conversion operation
This joint preserving method is suitable for correcting mild to moderate malpositions. The fixation of the bones can be done with a bioresorbable implant, and there is no need to remove the metal. In these cases, mobilisation with a therapeutic shoe without underarm crutches is possible.
Basal conversion operation
For higher-grade deformities, a basal conversion operation in combination with soft-tissue surgery is necessary. An angle-stable titanium plate is used here, which also allows for weight bearing with a therapeutic shoe.
Lapidus arthrodesis
Concomitant instability of the transition between the tarsal root and metatarsus requires stabilisation of the first metatarsophalangeal joint following Lapidus, in combination with soft-tissue surgery. This method makes it possible to safely correct extreme malpositions.
Akin osteotomy
In addition to classic hallux valgus deformity, hallux-interphalangeal malposition often occurs. The big toe curves inward here at the level of the basal member, which cannot be corrected alone with the methods mentioned above. Akin osteotomy is applied here, in which a wedge is removed from the basal member and the malposition is corrected. The fixation can be done with a self-dissolving (bioresorbable) suture and is often used in combination with the above-mentioned methods.

Rehabilitation – Time and methodology
Your hospital stay usually takes 3-5 days, depending on the surgical procedure. After the hallux valgus surgery you should not drive for six weeks. You may place weight on the foot on the first day after the surgery. A special therapeutic shoe is used for walking. Crutches, on the other hand, are usually not necessary. If the special shoe is no longer necessary, you can of course also wear open shoes again – from a cosmetic point of view as well because the surgical scars heal so they are barely visible. Once the hallux valgus has been operated on, it will not come back. You can wear normal shoes, but the shoes should not be uncomfortable and especially not too small.

Claw toe

Claw toe is a painful curvature of the toes. In many cases, this causes increased calluses and open skin damage. Even consistently performed conservative treatments in the early stages of the disease cannot always prevent a worsening of the condition.

Definition
Claw toe, which occurs frequently, arises from a contraction of the flexor and extensor muscles of the foot and often occurs together with a splayfoot or hallux valgus. A claw toe can often be corrected in the early stages without surgery. It should by no means be downplayed as a cosmetic problem or blemish; it is a serious deformation that should be examined by a specialist. At ATOS Clinics, condition-related causes such as deformities in the form of kinked, flat or splay feet are differentiated from causes such as neurological foot disorders and foot injuries. Too little time spent barefoot, or wearing unsuitable shoes can play a role.

Symptoms
If the causes of the claw toe are not eliminated, calluses and deformities progress, accompanied by more or less severe pain. The toes are raised permanently and often do not reach the floor while the toe joint is completely or partially dislocated.

Diagnosis
The typical appearance of the crooked toes and the calluses and bruises can be a sure indication of claw toe. An X-ray shows not only the deformation, but also the position of the articular surfaces to be corrected if necessary. Wear-related joint changes or dislocated joints are also recognisable. Claw toes should be considered a holistic symptom of the foot with possible interactions. Limiting therapy to the claw toe is not promising.

Conservative treatment
If the affected has not yet become rigid, conservative therapy can be tried. Special insoles, splints, rein bandages, toe gymnastics and care of the pressure points are the means of choice here.

Surgical treatment
If conservative therapy does not help with claw toes, surgical therapies should be considered. Claw toe surgery is usually not painful and can often be done as an outpatient surgery. Weight can then immediately be placed on the foot with a therapeutic shoe. At ATOS Clinics, appropriate interventions are carried out by our experts with lasting success. They use the following techniques:

Tendon transfer
Partially flexible deformities of the claw toes can be corrected with smaller soft tissue interventions. A tendon transfer is a possibility here for example. The toe flexor tendon is moved to the extensor side.
Hohmann operation
When stiffening of the claw toe can no longer be compensated for, the head of the basal member can be removed in a Hohmann operation and the shortened flexor tendon extended by manual correction.
Stabilisation
If a painful destruction of the toe joints has already occurred in the claw toe, an operative stabilisation can fix the malposition. A special implant is used here, which allows very rapid mobilisation.

Rehabilitation – Time and methodology
Your hospital stay usually takes 3-5 days, depending on the surgical procedure. A special therapeutic shoe is used for walking. Crutches, on the other hand, are usually not necessary. If the special shoe is no longer necessary, you can of course also wear open shoes again – from a cosmetic point of view as well because the surgical scars heal so they are barely visible.

Splayfoot

A splayfoot arises when the arch of the forefoot has sunken and the entire forefoot has widened. As a result, the sole of the foot can become very painful over the metatarsal heads (metatarsalgia).

Definition
Splayfoot does not cause any major complaints in minor cases. It is more common in women than in men. There are many causes and many factors come together in most cases. Splayfoot is often the result of hereditary predisposition, especially if it occurs with hallux valgus. Increased burden on the forefoot caused by excessive weight is also a possible cause. Rheumatic diseases can also lead to this foot deformity. In women, there is a predisposition to splayfoot due to connective tissue weakness. Wearing high-heeled, pointed toe shoes promotes the emergence of this deformity. Metatarsalgia usually starts with discomfort in shoes that become increasingly tight due to the widening of the forefoot. This is the technical term for the pain resulting from the splayfoot deformity.

Symptoms
In particular, the increased occurrence of corneal calluses under the second and third metatarsal head lead to massive stress in the sole of the foot. If the toes are additionally constricted by prolonged wearing of pointed shoes, the tendons will shift. This pulls the toes in a crooked position over time. Extreme malpositions eventually lead to the dislocation of the little toes and the joints popping out. This leads to extreme pain and is a surgical emergency.

Chronic irritation of the plantar nerves may also develop it so-called Morton’s neuralgia. This is a pain syndrome as a result of nerve inflammation, which leads to a piston-like distension of the nerves. The adjacent metatarsal heads cause additional friction, resulting in a nerve constriction syndrome. The result is heavy stress on the sole of the foot with paresthesia in the toe gaps. The sequelae related to developed splayfoot may be hallux valgus, a tailor bunion with a small tenfold position (digitus quintus varus) or claw/hammer toes. There is also the risk of osteoarthritis in the tarsal joints.

Diagnosis
When diagnosing splayfoot, determining the exact causes is important. At ATOS Clinics, we therefore examine the feet very precisely and also use our modern imaging diagnostics. Based on this, we can accurately identify the foot malformations and develop a therapy tailored to the patient’s personal needs before surgery. A splayfoot is clearly visible when standing on the basis of the typical lowering of the arch of the foot and the widening of the forefoot. The spread of the metatarsus and the changed angle between the first and second metatarsal bones can be precisely determined by means of an X-ray. With a so-called minus index, in which the second metatarsal bones clearly dominate the others, the predisposition for the development of a metatarsalgia is clear. With a foot pressure measurement (pedography) the overload of the second and third metatarsal head can be shown clearly.

Conservative treatment
The aim of a conservative therapy of splayfoot at ATOS Clinics is relief of the foot or a weakening of the burden placed on the foot. However, it is not possible to permanently raise the transverse arch again using conservative treatment for splayfoot. In minor cases, it helps to wear more comfortable, sufficiently wider and non-constricting shoes. The known risk factors for the further development of the disease should be specifically reduced or eliminated.

Foot-gymnastics is recommended under the guidance of a physiotherapist. Gripping exercises with the toes and various forms of barefoot running can strengthen the muscles. Immobilization, wet compresses and painkillers help when the feet hurt. Severe pain can be reduced by injecting growth factors (autologous conditioned plasma) or more specifically high molecular weight hyaluronic acid. Cortisone injections may help with Morton’s neuralgia, but should be avoided around the joint capsule. They lead to a weakening of the joint capsule, which can lead to a luxation (dislocation) of the small toe.

Special insoles with soft zones, which are made according to a computer-aided foot pressure measurement, alleviate discomfort. The insoles are made of carbon, so they can be kept very thin and allow you to wear even more elegant shoes.

Surgical treatment
The foot deformity associated with splayfoot cannot be completely eliminated by conservative therapies. If there is no adequate reduction of the symptoms, surgical therapies should be considered. At ATOS Clinics, such interventions are carried out almost painlessly and with lasting success. The entire foot is always considered as a unit to treat accompanying pathologies. This is the only way to achieve the best results.

Weil osteotomy
With Weil osteotomy, the aspect ratio of the metatarsals is surgically corrected. The metatarsal head is shortened by a few millimetres to remove it spatially from the painful callus and to allow harmonious weight-bearing in the entire forefoot. The joint is preserved. The bone is fixed with a special titanium screw, only 1.3 millimetres thick, which can remain in the body for a long time. The painful calluses heal automatically after conversion of the bones. Weight can be placed on the foot immediately after surgery with a therapeutic shoe.
Transfer osteotomy with Tailor bunion
Similar to hallux valgus, a bony corrective osteotomy of the affected metatarsal bone is carried out here. Due to the modified axis technique following Scarf, a narrowing of the forefoot and thus freedom from pain can be achieved by local pressure relief. A possible malposition of the fifth little toe (digitus quintus varus) can be corrected again.
Morton’s neuraligia
With so-called Morton’s neuralgia, a small splayfoot operation is performed with a minimally invasive technique. The aim is to relieve the nerve bundle by removing the pressure on the nerve bundles by cutting surrounding connective tissue and freeing the nerve. With massive tumorous issues in the nerves, this node is also completely removed and a histological examination of the tissue (histology) is preformed. Weight can be placed on the foot again a few days after the splayfoot operation.

Rehabilitation – Time and methodology
Your hospital stay usually takes 3-5 days, depending on the surgical procedure. A special therapeutic shoe is usually used for walking. If the special shoe is no longer necessary, you can of course also wear open shoes again – from a cosmetic point of view as well because the surgical scars heal so they are barely visible.

Ankle arthritis

The ankle has to endure the greatest stress among all the joints and is therefore particularly prone to various injuries. Pain in this area is always an alarm signal for joint wear.

Definition
The upper ankle is part of the ankle. Together with the lower ankle, it connects the foot to the lower leg. It lies between the lower leg (fibula and tibia) and the talus and allows the foot to move up and down. The lower ankle allows for lateral foot movements. Strong inner and outer ligaments connect the bones in the joint. The mobility of the joint is necessary for rolling of the foot and pushing when jumping.

The joint also allows humans to have an upright gait. It has to withstand a load up to seven times its own body weight even during normal walking. Like all joints, the upper ankle joint also has a cartilaginous layer that provides lubricity. The cartilage layer also serves as suspension and shock absorber and is subject to natural wear. Injuries, which occur more often in the upper ankle because of its high mobility and loads, accelerate the wear of the protective cartilage layer.

Complaints at this point are subject to a self-reinforcing cycle. Damage or injury such as an outer ligament rupture always triggers restricted movement. This restricted movement causes misalignment with a shift in loading. The additional load resulting from displacement of the load axis triggers further damage or injury. And the vicious circle continues.

Symptoms
The degree of pain depends on the stage of ankle osteoarthritis. Initially there are hardly any symptoms of joint wear and tear. The first signs of deep-seated pain are noticeable. Later, morning start-up and stress pain occur. Patients cannot properly roll the joint. Chronic pain occurs and the joint stiffens in the later stage.

Common symptoms include:

Start-up and stress pain
Stinging pain
The resulting restrained posture
Stinging pain when walking on uneven ground
Stiffening of the ankle

Diagnosis
If there is a specific suspicion of ankle osteoarthritis, the gait pattern is first examined as are malpositions of the leg axis. A footprint measurement (podometry) is also a common diagnostic procedure. Imaging procedures (X-ray and/or CT) indicate the bony change in the soft cartilage. The joint space is reduced and the bone itself thickened.

Conservative treatment
The onset of wear of the upper ankle joint can be treated first with physiotherapy, shoe inserts or hyaluronic acid injections in case of complaints.

Surgical treatment
Should these conservative measures no longer be sufficient, operational measures may become necessary. Here is a selection of common methods:

Arthroscopy of the upper ankle
In arthroscopy of the upper ankle, unstable cartilage is removed and adhesions and outgrowths are removed. Damaged parts of cartilage are smoothed with the help of special instruments and the targeted use of cartilage techniques can stimulate the formation of new cartilage.
Transfer osteotomy of the upper ankle
In special cases, the possibility of a joint-retaining transfer osteotomy makes sense with axis malpositions or unilateral wear of the upper ankle joint. In this procedure, a bony correction of the load axis of the ankle is done with the aim to relieve the damaged joint parts and to maintain the natural joint as long as possible.
Artificial joint (OSG TEP)
In advanced arthritis of the upper ankle, it is possible to implant an artificial joint or fuse the joint. The advantage of the artificial joint is the preservation of the function of the joint. The rolling behaviour is maintained and with it normal movement. Weight can be placed on the foot early after surgery with specially developed therapeutic boot.
Fusion operation (arthrodesis)
The fusion operation also leads to pain relief and has the advantage that it does not need to be reoperated. With this operation, the usually only painful residual mobility of the joint is converted into a permanent and painless joint stabilisation. This operation can also be performed arthroscopically. The foot is resilient and stable again after 3 months of rest.

Rehabilitation – Time and methodology
The post-treatment depends on the respective surgical technique. If your ankle has been fused, your joint will be immobilised for 8-12 weeks with an orthosis attached. You should practice walking beginning in week 13.

Your foot and ankle specialists at ATOS Clinics

All our doctors have many years of experience. Find your specialist here and make an appointment. The order of our doctors in the following is purely alphabetical and does not represent a qualitative ranking.