Managing Foot and Ankle Arthritis in Sport

This session included presentations on: The natural history of ankle arthritis in sports; Non-surgical management for arthritis in the ankle – strategies to keep playing; Surgery for ankle arthritis: timing and return to play; End-stage arthritis: is arthrodesis or arthroplasty of the ankle career ending?; Hallux rigidus – non-surgical strategies to continue playing; and Hallux rigidus – what is the best operation to continue playing?

Ankle osteoarthritis (OA) is relatively uncommon but disabling and is almost exclusively post-traumatic. It is the result of an interaction between abnormal contact pressure and biological factors. Early intervention is needed to reduce disease progression through the control excessive inflammation and mechanical loading, and to re-establish normal movement, proprioception and strength. Medical interventions are typically performed for flare-ups. End-stage OA of the ankle is probable career ending and fusion is a last resort. With other joints, such as the subtalar and talo-navicular joint, midfoot and in hallux rigidus, fusion can have good functional results. Non-surgical management of hallux rigidus to allow continuation of play is quite high maintenance, but aims for the best achievable foot function, prevention of secondary issues and involves bespoke orthotics, stiffer boots and physiotherapy. Surgical options for hallux rigidus include cheilectomy, which has less good results with more advanced disease. Osteotomy is a possible adjunct but is hard to get right. Interposition is possibly good for sedentary individuals but long-term data is lacking for athletes. Fusion is a tried and tested option for true end-stage disease and may allow return to low impact sport, whereas joint replacement is not recommended for anyone.