Edited by Ariel Palanca, MD
An Ankle cheilectomy (bone spur removal) is used to treat anterior ankle impingement resulting from certain injuries or from ankle arthritis. Anterior ankle impingement causes a pinching, painful sensation at the front of the ankle joint. Bone spurs or other soft tissue swelling can sometimes be felt beneath the skin. X-rays, bone scans, or 3-dimensional imaging (CT scan or MRI) will help to show the ankle joint and the bone spurs clearly. The bone spurs may be on the tibia, the talus, or both. Ankle cheilectomy may be offered if non-surgical treatment is not effective.
Patients with anterior impingement may experience symptoms when walking uphill or with squatting (when the front of the shin moves toward the foot). Sometimes, patients will feel weakness or instability of the ankle due to pain, or may feel that they are “walking with the foot turned outward.”
Ankle cheilectomies are most effective when performed on patients who have mainly healthy ankle joints, with pain specifically at the front of the ankle. If most of the joint is healthy, and only the front of the joint shows narrowing or bone spurs, then removing the prominent impinging bone spurs and/or anterior soft tissue can help symptoms considerably.
If there is evidence of injury to other parts of the ankle (from fractures or sprains) or there is more significant ankle arthritis, then sometimes only partial relief of symptoms can be expected from removing bone spurs and scar tissue from the front part of the ankle. In some instances, surgery to remove the bone spurs can contribute to an unwanted increase in a patient’s symptoms since the surgery is designed to allow the ankle joint to move more, and more movement may irritate the other damaged areas of the ankle. Generally speaking, more arthritis usually means less benefit from the cheilectomy procedure.
Surgical treatment involves removing the prominent bone spurs and/or soft tissue or scar tissue in the front of the ankle. This is done either arthroscopically, or by opening up the ankle joint with an incision. An ankle cheilectomy for small areas of spurs/tissue can usually be performed arthroscopically. However, if the bone spurs are large, it is often more efficient and effective to make a larger incision, open up the ankle joint, and remove the bone spurs. The procedure is typically outpatient surgery.
Recovery requires limited activities for 6-8 weeks, during which time the patient’s ankle will be swollen and painful. However, patients may be able to weight-bear immediately after surgery if an ankle cheilectomy was the only procedure performed. Crutches and/or an air walker brace may be prescribed to enhance comfort after the procedure. Physical therapy to gradually mobilize the joint safely and comfortably will often be prescribed as well. It is important to recognize that ligaments and tendons may be tight before surgery, patients should expect improved, but not fully normal ankle range of motion even after surgery and rehabilitation. This may contribute to less improvement than expected in some cases.
The bone spurs themselves often tend to ‘grow back’ gradually over time; therefore, recurrence of symptoms is possible. Athletes may continue to experience mild or moderate symptoms in the long term.
Previously Edited by Gwyneth deVries, MD
Edited on January 18, 2018