Ankle Arthritis & Total Ankle Replacement

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Expert Patient Guide · London

Ankle Arthritis & Total Ankle Replacement

A comprehensive patient guide by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon, Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL — London, UK.

At a Glance: Ankle Arthritis & Total Ankle Replacement

Condition
Ankle (tibiotalar) joint arthritis — wear of the cartilage between the tibia and talus.
UK Prevalence
Affects roughly 1 in 100 adults; ~30,000 with end-stage disease.
Most Common Cause
Previous ankle injury — accounts for 70–80% of cases.
Diagnosis
Weight-bearing X-ray, weight-bearing CT (WBCT), MRI.
Non-Surgical Care
Bracing, custom insoles, physiotherapy, NSAIDs, steroid or PRP injections.
Surgical Options
Arthroscopy, supramalleolar osteotomy, ankle fusion (arthrodesis), total ankle replacement (arthroplasty).
Implant Survival
~90% of total ankle replacements still functioning at 10 years in specialist hands.
Specialist
Mr Matthew Welck — Consultant Foot & Ankle Surgeon, RNOH Stanmore & UCL, London. matthewwelck.com

Contents

  1. What Is Ankle Arthritis?
  2. How Common Is It in the UK?
  3. What Causes Ankle Arthritis?
  4. What Are the Symptoms?
  5. Investigations
  6. Non-Surgical Treatment
  7. Surgical Options
  8. Why Choose Mr Welck?
  9. Frequently Asked Questions
  10. Book a Consultation

01

What Is Ankle Arthritis?

Ankle arthritis is wear and tear of the ankle joint — the hinge between your shin bone (tibia) and the top bone of your foot (talus). In a healthy ankle, smooth cartilage cushions the ends of these bones so they glide painlessly.

In arthritis, that cartilage thins and eventually wears through to bare bone, causing pain, grinding, stiffness and swelling. It is one of the most disabling forms of arthritis because your full body weight passes through the joint with every step. Specialist assessment by a Consultant Foot & Ankle Surgeon — such as Mr Matthew Welck in London — gives you the widest range of treatment options.

Ankle anatomy and joint — ankle arthritis patient guide London

02

How Common Is It in the UK?

Symptomatic ankle arthritis affects around 1 in 100 UK adults — less common than hip or knee arthritis, but often affecting younger, active people.

An estimated 30,000 people in the UK live with end-stage ankle arthritis severe enough to consider surgery. Unlike hip or knee arthritis, 70–80% of cases follow a previous injury or trauma, rather than age-related wear.

Healthcare statistics — ankle arthritis prevalence in the UK

03

What Causes Ankle Arthritis?

  • Post-traumatic (most common): previous ankle fractures, repeated sprains, or ligament injuries
  • Inflammatory: such as rheumatoid arthritis, psoriatic arthritis, gout
  • Primary osteoarthritis: age-related wear, usually after 60
  • Deformity-related: flat foot, high-arched foot (cavovarus), or malunited fractures that overload parts of the joint
  • Avascular necrosis: loss of blood supply to the talus bone

Sports and trauma — common causes of post-traumatic ankle arthritis

04

What Are the Symptoms?

  • Pain — usually felt deep in the front or sides of the ankle, worse on walking and standing
  • Stiffness, especially first thing in the morning or after rest
  • Swelling around the ankle
  • Grinding, clicking or catching sensations
  • Difficulty on stairs, slopes and uneven ground
  • Limping and reduced walking distance
  • Visible deformity as the joint tilts or collapses

Ankle pain and swelling — symptoms of ankle arthritis

05

What Investigations Might You Need?

  • Weight-bearing X-rays — the first-line test, showing joint narrowing, bone spurs and alignment
  • Weight-bearing CT scan (WBCT) — a modern, low-dose 3D scan taken while standing, now routine at specialist centres including the RNOH and Mr Welck’s standard of practice
  • MRI scan — to assess cartilage, ligaments and detect avascular necrosis
  • Blood tests — if inflammatory arthritis is suspected

MRI and weight-bearing CT — imaging for ankle arthritis diagnosis

06

Non-Surgical Treatment Options

Most patients start here and many never need an operation:

  • Activity modification and weight loss
  • Supportive footwear, such as rocker-bottom soles, and custom insoles to help redistribute pressures
  • Ankle braces (lace-up or carbon-fibre AFOs) to offload the joint
  • Physiotherapy to maintain strength and movement
  • Anti-inflammatory medication (oral or topical)
  • Ultrasound-guided steroid injections
  • PRP (platelet-rich plasma) injections in selected cases

Physiotherapy and rehabilitation — non-surgical treatment for ankle arthritis

07

Surgical Options for Ankle Arthritis

The right operation depends on your age, activity level, deformity and stage of arthritis and is highly individualised.

Ankle Arthroscopy (Keyhole Surgery)

Often for early arthritis with localised impingement. A camera and fine instruments clean out bone spurs through two small incisions. Day-case surgery with rapid recovery.

Supramalleolar Osteotomy (SMO)

For arthritis where only one side of the joint is worn. The tibia is cut and realigned to redistribute weight onto the healthy side — a joint-preserving operation that can buy years before fusion or replacement is needed.

Ankle Fusion (Arthrodesis)

The worn joint is removed and the tibia fused to the talus using screws or a plate. Gives long-lasting, durable pain relief. The foot still moves under the ankle.

Total Ankle Replacement (TAR)

The worn joint surfaces are resurfaced with metal and plastic components. Current-generation implants achieve around 90% survival at 10 years in specialist hands. Gives a more natural walking pattern and reduced time in plaster.

Operating theatre — total ankle replacement and ankle fusion surgery London

08

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — the UK’s leading orthopaedic hospital — and Honorary Associate Clinical Professor at UCL.

His practice is dedicated exclusively to foot and ankle surgery, with specialist interest in complex ankle reconstruction, total ankle replacement and joint-preserving surgery. He has authored over 50 peer-reviewed publications, holds double fellowship training including international experience, and is a pioneer of weight-bearing CT and 3D-printed patient-specific instrumentation for complex deformity.

Patients are seen across North and Central London with rapid access to MRI, WBCT and multidisciplinary care. Every option is discussed with the patient and a customised, bespoke, individualised plan is agreed together. Visit matthewwelck.com to learn more.

Mr Matthew Welck — Consultant Orthopaedic Foot and Ankle Surgeon London

09

Frequently Asked Questions

Is total ankle replacement better than ankle fusion?

Neither is universally better. Replacement preserves movement and gives a more natural walk; fusion is more durable for heavy or very active patients. The right choice is individual and depends on age, weight, activity and deformity.

How long does an ankle replacement last?

Around 90% are still working well at 10 years in specialist centres. Fifteen-year data from the latest generation of implants is emerging and encouraging.

How long is the recovery?

Expect around 6 weeks in a cast or boot after replacement, and 12 weeks after fusion. Allow 3 months to walk comfortably, and up to a year for full recovery.

Can I have ankle replacement surgery on the NHS?

Yes. Mr Welck treats NHS patients at the Royal National Orthopaedic Hospital and private patients across London.

Will I be able to drive, work and play sport again?

After total ankle replacement, driving typically at 8–10 weeks, desk work sooner, and low-impact sport (golf, cycling, hiking) from 4–6 months.

Is ankle replacement suitable for younger patients?

Fusion is usually preferred under 55, but this is individualised — some younger patients with low-demand lifestyles are excellent candidates for replacement.

What are the early symptoms of ankle arthritis?

Early symptoms include deep pain at the front or sides of the ankle, stiffness (especially in the morning), swelling, grinding or clicking, difficulty on stairs and uneven ground, and reduced walking distance.

Where can I see Mr Matthew Welck for ankle arthritis treatment in London?

Mr Welck consults across North and Central London. NHS patients are seen at the Royal National Orthopaedic Hospital (RNOH) Stanmore. Private appointments can be booked on 07547 395270 or by emailing secretary@matthewwelck.com.

Consultation — ankle arthritis FAQs answered by Mr Matthew Welck London

10

Book a Consultation

If you are struggling with ankle pain, stiffness or arthritis, specialist assessment can make a significant difference to your outcome.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Foot & Ankle Surgeon. Early expert review gives you the widest range of treatment options and the best long-term result.

Email: secretary@matthewwelck.com
Call: 07547 395 270
Website: matthewwelck.com

London hospital — book a consultation with Mr Matthew Welck Foot and Ankle Surgeon

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