- Advise patients that ligaments may take longer to recover than fractures
- Defined as OA of the tibial-talar joint.
- 2/3 of cases are post traumatic
- Patients typically complain of pain on weight-bearing and stiffness.
- Examination may reveal a joint effusion, with painful and restricted ROM +/- deformity and crepitus.
- Blood tests and radiography are not usually indicated as part of a primary care assessment of suspected osteoarthritis.
NICE recommend Core treatment should be offered to all patients prior to referral for surgical opinion.
- Provide verbal and written information to patient.
- Advise strengthening exercises and aerobic fitness training including cycling and swimming. Weight loss.
- Ankle brace or orthotic.
Analgesia should include:
- Regular paracetamol
- Topical NSAIDs
- Consider oral NSAIDs, opiods Utilise the NHS shared decision making aids (URL)
- Diagnostic uncertainty
- Failure of conservative measures.
- Pain, stiffness, reduced function impacting on QoL.
- Referral for physiotherapy / orthotics
- Referral for steroid injection
- Referral for consideration of arthroscopy, fusion or replacement.