The exam and xrays reveal tibiotalar anterior impingement without subtalar involvement. Tibiotalar impingement during dorsiflexion with concomitant mild arthritis can be treated with anterior ankle cheilectomy/debridement (arthroscopic or open). Ankle arthrodesis with cancellous screws remains the gold standard for surgical treatment of more severe ankle arthritis . Ankle arthroplasty is another option however it is technically demanding with potential complications. Illustration A shows a radiograph following arthroscopic anterior tibiotalar debridement.
Level 4 evidence from Monroe et al found a 93% rate of tibiotalar fusion using cancellous screws for fixation. Holt et al also found a 93% rate of fusion in low risk patients and 74% fusion rate overall. Similarly, Dennis et al found a 94% rate of fusion using cancellous screws for internal fixation.
Holt ES, Hansen ST, Mayo KA, Sangeorzan BJ. Ankle arthrodesis using internal screw fixation. Clin Orthop Relat Res. 1991 Jul;(268):21-8.
PMID:2060210 (Link to Abstract)
Monroe MT, Beals TC, Manoli A 2nd. Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws. Foot Ankle Int. 1999 Apr;20(4):227-31.
PMID:10229278 (Link to Abstract)
Dennis DA, Clayton ML, Wong DA, Mack RP, Susman MH. Internal fixation compression arthrodesis of the ankle. Clin Orthop Relat Res. 1990 Apr;(253):212-20.
PMID:2317977 (Link to Abstract)