title: Stretching the indications: high tibial osteotomy used successfully to treat isolated ankle symptoms.
abstract: High tibial osteotomy (HTO) is successful in treating symptomatic varus arthritis of the knee. We present a case where ankle pain and instability were attributed to varus ankle malalignment. This was found to be secondary to constitutional varus of the proximal tibia but the patient's knee was asymptomatic. The decision to operate on an asymptomatic knee in the hope of improving ankle symptoms took a period of careful consideration, planning and discussion. HTO was performed without immediate complication and the patient reported an excellent outcome with marked improvement in Mazur's foot and ankle score from 18 to 85. In well selected and planned cases, HTO may be considered as an instrument of deformity correction with improvement in symptoms from joints distant to the surgical site.
authors.affiliation: Department of Orthopaedics, Cumberland Infirmary, Carlisle, UK.
authors.forename: David W
authors.initials: DW
authors.lastname: Elson
authors.forename: James E
authors.initials: JE
authors.lastname: Paweleck
authors.forename: David W
authors.initials: DW
authors.lastname: Shields
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Dawson
authors.forename: Gail M
authors.initials: GM
authors.lastname: Ferrier
mesh_terms: D000843:Ankle Joint; D018771:Arthralgia / Q000209:etiology; D001848:Bone Diseases, Developmental / Q000150:complications / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055034:Osteochondrosis / Q000150:complications / Q000151:congenital* / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
references.citation: J Bone Joint Surg Am. 1965 Jul;47:984-90
references.pmid: 14318636
references.citation: Knee. 2008 Jun;15(3):196-200
references.pmid: 18367399
references.citation: Arthroscopy. 1993;9(2):159-63
references.pmid: 8461073
references.citation: Knee. 2004 Dec;11(6):439-44
references.pmid: 15581761
references.citation: J Bone Joint Surg Am. 2003 Mar;85(3):469-74
references.pmid: 12637433
references.citation: J Bone Joint Surg Br. 1998 Jan;80(1):63-9
references.pmid: 9460955
references.citation: Clin Orthop Relat Res. 1989 Sep;(246):250-9
references.pmid: 2766613
references.citation: Knee Surg Sports Traumatol Arthrosc. 2013 Jan;21(1):1-2
references.pmid: 22878439
references.citation: Clin Orthop Relat Res. 2006 Nov;452:91-6
references.pmid: 16906111
references.citation: Orthop Clin North Am. 1994 Jul;25(3):425-65
references.pmid: 8028886
references.citation: J Bone Joint Surg Am. 1979 Oct;61(7):964-75
references.pmid: 489661
references.citation: J Bone Joint Surg Br. 2008 May;90(5):592-6
references.pmid: 18450624
references.citation: Clin Orthop Relat Res. 2007 Sep;462:156-68
references.pmid: 17563701
references.citation: J Bone Joint Surg Br. 2008 Dec;90(12):1548-57
references.pmid: 19043123
references.citation: Clin Orthop Relat Res. 1985 Sep;(198):43-9
references.pmid: 4028566