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Patients › Ankle

Total ankle replacement

PDF Evidence Consent
Updated Sep 2026
Illustration: ankle

Why this operation has been suggested

Ankle arthritis means the smooth surface inside the joint has worn away, so bone rubs on bone. It often follows a fracture or a severe sprain of the ankle. It can be as disabling as arthritis of the hip. For most people with this long-standing problem, we start with non-operative care such as activity change, physiotherapy, and splinting, and consider surgery when that has not given enough improvement.

Total ankle replacement replaces the worn surfaces of your ankle joint with an artificial implant. It is one of two operations for end-stage ankle arthritis; the other is ankle fusion, where the bones are set to grow together. We will talk through both with you. Patient satisfaction with ankle replacement typically exceeds 90%, and the operation aims to relieve pain and restore movement so you can walk and stay active more comfortably.

Before the operation

Once surgery is planned, we arrange the imaging needed to prepare: weight-bearing X-rays of your ankle, and sometimes an MRI or ultrasound scan to look closely at the joint, the cartilage and the soft tissues around it. On the day of your operation, you will need to stop eating and drinking seven hours beforehand. We ask for seven hours rather than a shorter time so that we can bring your operation forward if the theatre list runs early. Some medications need to be paused before surgery; your surgeon will tell you which ones and when to stop them. Bring a written list of everything you take, wear loose, comfortable clothing, and arrange for someone to drive you home afterwards. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.

On the day

You will come to the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You will meet the anaesthetist, who looks after your anaesthetic. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day. You are then taken into the operating theatre, where the operation is performed.

You will wake up in the recovery area, where nurses watch over you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and how your recovery is going.

What the operation involves

Total ankle replacement replaces the worn surfaces of your ankle joint with artificial parts, usually made of metal and plastic. Your surgeon removes the damaged bone and cartilage from the ends of the bones that meet at your ankle, then shapes them to fit the new joint surfaces. The new parts are fixed into place so they can move smoothly against each other, much like a healthy ankle does.

The operation is done through a cut at the front of your ankle. Some designs also use a short stem that sits inside the main bone of the lower leg to hold the implant steady. Your surgeon may also lengthen a tight tendon at the back of your ankle during the same operation if that will help your ankle bend better afterwards.

Once the implant is in place and checked, the cut is closed with stitches and covered with a dressing. You will keep that dressing on for about 10 days, as described in the recovery section.

The exact implant used varies, and the designs keep improving as surgeons learn more about which shapes and materials work well. Your surgeon will talk you through the plan for your ankle before the operation, including whether any extra steps are needed based on what your scans show.

After the operation

You will wake up in the recovery area with nurses watching over you while the anaesthetic wears off. Once you are stable, you move to the ward or go home. Your team will tell you whether you go home the same day or stay one night in hospital. Pain relief is planned for you before the anaesthetic wears off; tell your nurse if your pain is not settling. Your ankle will be wrapped in dressings, and we leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you. You will be helped to stand and take a few steps soon after the operation, with crutches or a frame for support. Someone should stay with you for the first 24 hours after you get home.

Recovery

The first days are about rest and swelling. Your ankle will be sore and puffy, and the skin may look bruised. Keeping your foot raised above the level of your heart, using ice packs wrapped in a towel, and taking your pain relief as prescribed all help settle this. Swelling usually peaks in the first few days, then eases gradually. It can come and go for a while, especially after you have been on your feet.

You will be helped to stand and take a few steps soon after the operation, using crutches or a frame. Your physiotherapist will guide you through exercises to keep the rest of your leg moving and, once your surgeon is happy with how things are healing, to build movement and strength in the ankle itself. You will wear a boot or similar support while the ankle settles, and you will be shown how to put weight on the foot as it is ready. At home, keep your foot up when you sit, walk short distances as advised, and avoid standing for long stretches. Sleeping on your back with your foot raised is often most comfortable.

Recovery varies from person to person. Some people feel steady on their feet sooner than others, and swelling can linger longer than expected without meaning anything is wrong. Your timeline may differ from someone else's, and your surgeon and physiotherapist will guide you at each stage. Once the swelling settles and your ankle moves more freely, you will find walking and everyday activities gradually feel easier.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Sometimes the bone around the new joint slowly wears away. You may notice a dull ache near the implant, or your ankle feeling less steady than before. This is picked up on X-rays at your reviews, so keep your follow-up appointments even if your ankle feels fine. If the wearing is caught early, it can often be treated without redoing the whole replacement.

Infection around a new joint is uncommon but serious. Watch for a deep, throbbing pain that does not ease with simple painkillers, redness that spreads out from the wound, or fluid leaking from the cut. You may feel hot and shivery. Tell us straight away if you notice any of these, or go to the emergency department if you feel unwell.

A blood clot can cause sudden swelling and tenderness in the calf, sometimes with warmth or a heavy feeling in the leg. If a clot travels to the lungs it can bring breathlessness or chest pain. These signs need urgent attention, so go to the emergency department or call for help rather than waiting.

The bone at the edge of the ankle can crack while the new parts are being fitted. This is usually found during the operation and treated then, but it can mean a longer time in the boot or cast afterwards. If you feel a sharp, new pain in the bony bumps on either side of your ankle soon after surgery, let us know.

The wound on the front of your ankle can be slow to settle. Watch for gaping edges, increasing redness, or oozing. Mention it at your review or call the clinic, as some wounds need extra care from our team.

Extra bone can sometimes form near the new joint and cause a pinching feeling at the front of the ankle, especially when you bend your foot up. If this stays painful, a small keyhole operation can clear it.

If a replacement wears out or fails years later, there are still options. These include another replacement or turning the ankle into a fusion, where the bones are set to grow together.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Most problems show up early, and quick action makes them easier to treat. Call us if you have a fever, increasing redness or discharge from the wound, or pain that keeps getting worse instead of settling. Go to emergency if you have sudden calf swelling or tenderness, breathlessness or chest pain, because these can be signs of a blood clot. Go to emergency if you lose feeling in your foot or cannot move it. If you are unsure whether something is normal, call the clinic and we will help you decide.

Reviewed by AI synthesis (v2) — pending human review · 9 September 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Bony Anatomy

  • The ankle mortise is formed by the tibial plafond, medial malleolus, and lateral malleolus [5].
  • The ankle mortise articulates with the dome of the talar body [5].
  • The talar dome is wider anteriorly and narrower posteriorly [5].
  • The ankle mortise widens 1 to 1.5 mm during motion from plantar flexion to dorsiflexion [5].
  • Medial and superior clear spaces appear wider with the foot in plantar flexion [5].
  • A simplified model of the ankle joint has a horizontal axis from anteromedial to posterolateral [5].
  • A simplified model of the ankle joint has a coronal axis from superomedial directed distally and laterally to the tip of the fibula [5].
  • The distal fibula has a convex medial surface [5].
  • The incisura fibularis is the concave surface of the distal lateral tibia [5].
  • The fibula rotates approximately 2 degrees within the incisura during ankle motion and ambulation [5].
  • Ankle dorsiflexion results in external rotation and proximal translation of the fibula [5].

Ligamentous Anatomy

  • Lateral ankle ligaments function as restraints to varus and inversion forces at the ankle [5].
  • The anterior talofibular ligament (ATFL) originates from the anteroinferior aspect of the lateral malleolus, 1 cm proximal to its tip [5].
  • The anterior talofibular ligament extends to the lateral aspect of the talar neck [5].
  • The calcaneofibular ligament (CFL) extends from the tip of the lateral malleolus to the lateral aspect of the calcaneus [5].
  • The posterior talofibular ligament (PTFL) extends from the posterior lateral malleolus to the posterolateral talus [5].
  • The ATFL is the weakest ankle ligament [5].
  • The PTFL is the strongest ankle ligament [5].
  • The distal tibiofibular joint and fibula provide stability against lateral talar translation [5].
  • The deltoid ligament complex is the primary ankle stabilizer during stance [5].
  • The deep deltoid ligament extends from the apex of the medial malleolus to the medial talar body [5].
  • The deep deltoid ligament functions primarily to resist lateral talar translation and external rotation [5].
  • The posterior deep deltoid is the most important component of the deep deltoid ligament [5].
  • The superficial deltoid ligament extends from the distal medial malleolus to the navicular bone, sustentaculum tali of calcaneus, medial talus, and spring ligament [5].
  • The superficial deltoid ligament functions primarily to resist valgus and eversion ankle forces [5].
  • The deltoid ligament consists of superficial and deep layers, with at most six bands [11].
  • Only three bands of the deltoid ligament are constant: the tibionavicular ligament, tibiospring ligament, and deep posterior tibiotalar ligament [11].
  • The superficial layer of the deltoid ligament originates from the anterior malleolus and inserts into the navicular, neck of the talus, sustentaculum tali, and posteromedial talar tubercle [11].
  • The tibiocalcaneal portion of the superficial deltoid ligament is the strongest component and resists eversion of the calcaneus [11].
  • The deep portion of the deltoid ligament is the primary medial stabilizer of the ankle joint [11].
  • The deep deltoid ligament is organized into two short, thick, discrete bands: the anterior and posterior deep tibiotalar ligaments [11].
  • The anterior and posterior deep tibiotalar ligaments are intra-articular but extrasynovial [11].
  • The deep posterior band comprises the largest band of the deltoid complex [11].
  • The anterior deep tibiotalar ligament arises from the anterior malleolus and attaches to the medial aspect of the talus [11].
  • The posterior deep tibiotalar ligament originates from the posterior malleolus and inserts on the medial body of the talus [11].
  • The deltoid ligament has a rich vascular supply from three extraosseous sources: the medial tarsal artery, posterior tibial artery, and tibialis anterior artery [11].
  • The deltoid ligament also has intraosseous vascular supply from either the talus or the medial malleolus [11].
  • The deep deltoid ligament has the highest load to failure at 713.8 N ± 69.3 compared with the lateral collateral ligaments [11].
  • The dominant mode of failure for the deep deltoid ligament is an intrasubstance rupture near its talar insertion [11].
  • The failure of the superficial deltoid ligament is most commonly at its insertion on the anterior malleolus [11].

Biomechanics & Motion

  • The primary functions of the foot and ankle are to provide weight-bearing support and forward ambulation [5].
  • The ankle is responsible for most sagittal plane motion of the foot and ankle [5].
  • Ankle plantar flexion ranges from 23 to 48 degrees [5].
  • Ankle dorsiflexion ranges from 10 to 23 degrees [5].
  • The ankle contributes to inversion, eversion, and rotation [5].

Neurovascular Anatomy

  • The superficial peroneal nerve penetrates the deep fascia and lies subcutaneously 8 to 10 cm proximal to the tip of the lateral malleolus [9].
  • The anterior tibial artery can be palpated beneath the superior extensor retinaculum 4 to 5 cm proximal to the distal articular surface of the tibia [9].
  • The deep peroneal nerve accompanies the anterior tibial artery and lies between the tendons of the anterior tibial and extensor digitorum longus [9].
  • The deep peroneal nerve lies just lateral to the anterior tibial artery [9].
  • The saphenous nerve is located just medial or posterior to the saphenous vein in a slightly deeper plane 3 to 5 cm proximal to the tip of the medial malleolus [9].

Pathophysiology of Injury

  • More than 75% of ankle ligament injuries involve the lateral ligament complex, particularly the ATFL and CFL [12].
  • Medial ligament injuries are usually seen in association with a fracture or joint injury [12].
  • In an ATFL sprain, tenderness is maximal just distal and slightly anterior to the lateral malleolus [12].
  • The deltoid ligament primarily prohibits eversion and abduction [11].
  • The deep deltoid ligament resists external rotation when the foot is dorsiflexed [11].
  • The deep deltoid ligament is responsible for the greatest restraint against lateral translation [11].
  • Valgus tilting of the talus within the mortise requires complete rupture of both the superficial and deep deltoid ligaments [11].
  • Isolated rupture of the deltoid ligament without lateral ligamentous or fibular injury is rare [11].
  • Syndesmotic injury, lateral ligamentous injury, and fibular fractures are common associations with deltoid injury [11].
  • The criteria for diagnosis of medial instability include a feeling of giving way, medial ankle joint pain, and a correctable valgus or pronation deformity [11].
  • Medial instability is reinforced by excess motion in external rotation, eversion, valgus, and/or posterior translation [11].
  • With complete deltoid injury, a valgus AP stress radiograph shows talar tilt and/or lateral translation of the talus [11].
  • Most incomplete deltoid injuries are normal on standard radiographic imaging [11].
  • MRI is the imaging modality of choice for defining injury to the deltoid ligaments and associated structures [11].
  • Ankle arthroscopy allows direct assessment of the deltoid ligament with lateral stress applied to the talus [11].

Investigations

Osteochondral Lesions

  • Osteochondral lesions of the ankle are seen in up to 70% of ankle sprains and 75% of ankle fractures [15, 16].
  • The most common location for osteochondral lesions is the medial talar dome [15, 16].
  • Modern data indicate that the most common location for medial talar dome lesions is central, contradicting historical beliefs that the posterior location was more common [15, 16].
  • Medial talar dome lesions are larger and deeper than lateral lesions [15, 16].
  • Lateral talar dome lesions are less common than medial lesions [15, 16].
  • Lateral talar dome lesions are more often unstable, displaced, or symptomatic than medial lesions [15, 16].
  • Lateral talar dome lesions are often refractory to conservative measures [15, 16].
  • Physical examination for osteochondral lesions demonstrates deep pain over the ankle joint line [15, 16].
  • Palpation often does not reproduce the symptoms described by patients with osteochondral lesions [15, 16].
  • Ankle effusion is common in patients with osteochondral lesions [15, 16].
  • AP, mortise, and lateral weight-bearing ankle x-rays may not demonstrate subtle osteochondral lesions [15, 16].
  • CT scan is helpful for determining the integrity of subchondral bone and identifying cysts in osteochondral lesions [15, 16].
  • MRI is sensitive for all osteochondral lesions [15, 16].
  • The edema pattern on MRI frequently overestimates the severity of osteochondral injury [15, 16].
  • Linear fluid signal deep to subchondral bone on MRI indicates an unstable osteochondral injury [15, 16].
  • MRI has a sensitivity of 92% for predicting stable versus unstable osteochondral lesions [15, 16].

General Imaging and Diagnosis

  • Advanced imaging is often helpful in the diagnosis of foot and ankle injuries when combined with a thorough clinical examination [18].
  • MRI is used for the evaluation of tibiofibular syndesmotic ligaments [3].
  • MRI is used for the evaluation of posterior tibial tendon dysfunction [3].
  • MRI is used for the evaluation of anterolateral soft tissue impingement of the ankle [3, 20].
  • MRI is used for the evaluation of osteochondral lesions of the talus [3].
  • MRI is used for the diagnosis of ligamentous and chondral pathology in the ankle [3].
  • MRI and stress radiography are used in the evaluation of chronic lateral ankle instability [3].
  • MRI is used in the pre-operative evaluation of the anterior talofibular ligament in chronic ankle instability [3].
  • MRI is used for the diagnosis of ruptures of the tibialis posterior tendon [3].
  • MRI is used for the imaging evaluation of traumatic ligamentous injuries of the ankle and foot [3].
  • MRI is used for the diagnosis of plantar plate injury [3].
  • MRI findings are associated with symptoms in patients with chronic ankle sprain [3].
  • MRI is used for the evaluation of chronic Achilles tendon ruptures [3].
  • MRI is used for the evaluation of peroneal tendon abnormalities [17].
  • MR imaging is used for the evaluation of entrapment neuropathies of the lower extremity, including the ankle and foot [21].
  • Ultrasonography is used for the examination of the deltoid ligament in bimalleolar equivalent fractures [19].
  • Point-of-care ultrasonography is used in the diagnosis and management of superficial peroneal nerve entrapment [21].
  • MRI lacks additional diagnostic value for stability assessment of the ankle mortise in supination-external rotation-type ankle fractures [19].
  • Preoperative computed tomography scans are used in operative planning for malleolar ankle fractures [19].
  • Axial CT imaging is used to evaluate normal tibiofibular relationships at the syndesmosis [19].
  • Radiographic evaluation of the normal distal tibiofibular syndesmosis is a standard diagnostic consideration [19].
  • Fluoroscopy is used to assess if the syndesmosis is reduced [19].
  • The ankle fracture spur sign is pathognomonic for a variant ankle fracture [19].
  • Evaluation of posterior malleolar fractures and the posterior pilon variant is performed in operatively treated ankle fractures [19].
  • Stability criteria for nonoperative ankle fracture management are established via radiographic assessment [19].
  • Gravity stress radiographs are used to assess deltoid ligament integrity and medial clear space measurements [4].
  • Radiographic identification of primary lateral ankle structures is possible [4].
  • Comparison of magnetic resonance imaging to physical examination is performed for syndesmotic injury after lateral ankle sprain [4].

Treatment

Complications and Revision

  • Revision of failed total ankle arthroplasty can be performed as a hindfoot fusion [1].
  • Infection in total ankle arthroplasty requires specific diagnostic and treatment protocols [1].
  • Patient-related risk factors for periprosthetic joint infection have been analyzed in a cohort of 6977 total ankle arthroplasties [1].
  • Risk factors for symptomatic deep-vein thrombosis exist in patients after total ankle replacement who received routine chemical thromboprophylaxis [1].
  • Perioperative outcomes of total ankle arthroplasty differ when performed at an orthopaedic specialty hospital versus an academic teaching hospital [1].
  • Salvage of failed total ankle arthroplasty can be achieved with fusion using structural allograft and internal fixation [1].
  • Bone lysis of the AES total ankle replacement is subject to clinical evaluation and radiographic assessment [1].
  • Heterotopic ossification can occur after total ankle arthroplasty [1].
  • Risks associated with total ankle arthroplasty have been evaluated in the literature [1].
  • Short-term complications are associated with procedures performed through separate incisions during total ankle replacement [1].
  • The ankle arthritis score is associated with the need for revision surgery [1].
  • Patient risk factors do not impact 90-day readmission and emergency department visitation after total ankle arthroplasty [1].
  • Supramalleolar osteotomy is a treatment for tibial component malposition in total ankle replacement [1].
  • Hindfoot arthritis progression and arthrodesis risk occur after total ankle replacement [1].
  • Arthroscopic debridement is a management option after total ankle arthroplasty [1].
  • Failures of total ankle replacement can be managed with the Agility total ankle arthroplasty [1].
  • Blood transfusion during total ankle arthroplasty is associated with increased in-hospital complications and cost [1].
  • A three-grade classification of complications has been assessed for total ankle replacement [1].
  • Soft tissue reconstruction is performed after total ankle arthroplasty [1].
  • Operative wound complications occur following total ankle arthroplasty [1].
  • Bone grafting of bone cysts is an outcome management strategy after total ankle arthroplasty [1].
  • Secondary arthrodesis is performed after total ankle arthroplasty [1].
  • Short-term perioperative complications and mortality occur after total ankle arthroplasty in the United States [1].
  • The incidence of symptomatic thromboembolic events is low after total ankle arthroplasty without routine use of chemoprophylaxis [1].
  • Evaluation and management strategies exist for the painful total ankle arthroplasty [1].
  • Anterior heterotopic ossification at the talar neck can occur after total ankle arthroplasty [1].
  • Salvage arthrodesis is performed for failed total ankle replacement [1].
  • Platelet-rich plasma has been evaluated for its efficacy in incision healing after total ankle replacement using the Agility system [1].
  • Computed tomography has been evaluated for its added information on radiographic analysis in detecting periprosthetic osteolysis after total ankle arthroplasty [1].
  • The impact of complications in total ankle replacement and ankle arthrodesis has been analyzed with a validated outcome measurement [1].
  • Revision rates after total ankle arthroplasty have been reported in sample-based clinical studies and national registries [1].
  • Acute hematogenous periprosthetic joint infection in total ankle arthroplasty can be treated with irrigation, debridement, and polyethylene exchange [1].
  • Cigarette use is associated with complication rates and outcomes following total ankle arthroplasty [1].
  • Heterotopic ossification occurs after primary total ankle arthroplasty [1].
  • Delayed onset medial malleolar pain following total ankle arthroplasty has a defined etiology and treatment [1].
  • Periprosthetic fractures occur in total ankle replacement [1].
  • Postoperative range of motion trends have been documented following total ankle arthroplasty [2].
  • Total ankle arthroplasty outcomes have been compared for post-traumatic and primary osteoarthritis [2].
  • Total ankle arthroplasty has been reported in France [2].
  • Results of total ankle arthroplasty have been published [2].
  • The success of current ankle replacements has been evaluated in a systematic review of the literature [2].
  • The 10-year survival of total ankle arthroplasties was reported on 780 cases from the Swedish ankle register [2].
  • Outcomes after total ankle arthroplasty have been reported from worldwide arthroplasty registers [2].
  • Trends in total ankle arthroplasty and revisions have been analyzed in the Medicare database [2].
  • Inconsistency in the reporting of adverse events in total ankle arthroplasty has been identified in a systematic review [2].
  • Trends in the use of total ankle replacement and ankle arthrodesis have been analyzed in the United States Medicare population [2].
  • Changes in pain, function, and gait mechanics two years following total ankle arthroplasty performed with two modern fixed-bearing prostheses have been documented [2].
  • Trends in treatment of advanced ankle arthropathy by total ankle replacement or ankle fusion have been analyzed [2].
  • The utilization of total ankle replacement in the United States has been assessed [2].
  • Total ankle replacement was studied in a population-based study of 515 cases from the Finnish arthroplasty registry [2].
  • Practice patterns in total ankle replacement and ankle fusion in the United States have been compared [2].
  • Patient and practice trends in total ankle replacement and ankle arthrodesis in the United States from 2007 to 2013 have been analyzed [2].
  • The evolution of the technology and future applications of total ankle replacement have been discussed [2].

Complications

  • Revision of failed total ankle arthroplasty to a hindfoot fusion is a documented salvage procedure [1].
  • Perioperative outcomes for total ankle arthroplasty differ when performed at an orthopaedic specialty hospital versus an academic teaching hospital [1].
  • Salvage of failed total ankle arthroplasty can be performed with fusion using structural allograft and internal fixation [1].
  • Heterotopic ossification is a recognized complication after total ankle arthroplasty [1].
  • The risks associated with total ankle arthroplasty have been specifically evaluated [1].
  • Supramalleolar osteotomy is used to treat tibial component malposition in total ankle replacement [1].
  • A three-grade classification of complications in total ankle replacement has been assessed [1].
  • Anterior heterotopic ossification at the talar neck occurs after total ankle arthroplasty [1].
  • Computed tomography has been evaluated for its ability to add information on radiographic analysis in detecting periprosthetic osteolysis after total ankle arthroplasty [1].
  • The impact of complications in total ankle replacement and ankle arthrodesis has been analyzed using a validated outcome measurement [1].
  • Inconsistency exists in the reporting of adverse events in total ankle arthroplasty [2].

References

[1] Campbell S Operative Orthopaedics 4 Volume Set. Reported Outcomes of Ankle Arthroplasty Compared With Ankle Arthrodesis > COMPLICATIONS AND REVISION.

[2] Campbell S Operative Orthopaedics 4 Volume Set. Reported Outcomes of Ankle Arthroplasty Compared With Ankle Arthrodesis > REFERENCES.

[3] Campbell S Operative Orthopaedics 4 Volume Set. REFERENCES > FOOT AND ANKLE.

[4] Campbell S Operative Orthopaedics 4 Volume Set. REPAIR OF ACUTE RUPTURE OF LATERAL LIGAMENTS > ACUTE ANKLE LIGAMENT INJURIES, CHRONIC ANKLE INSTABILITY.

[5] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > BIOMECHANICS OF THE FOOT AND ANKLE.

[9] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > ANKLE BLOCK.

[11] Orthopaedic Knowledge Update Sports Medicine 6. Ankle and Foot Injuries and Other Disorders > Ankle Sprains > Medial Ankle Injury.

[12] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INJURIES OF THE ANKLE.

[15] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > OSTEOCHONDRAL LESIONS.

[16] Miller S Review Of Orthopaedics. OSTEOCHONDRAL LESIONS.

[17] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > PERONEAL TENDONS.

[18] Orthopaedic Knowledge Update Sports Medicine 6. Ankle and Foot Injuries and Other Disorders > Summary.

[19] Orthopaedic Knowledge Update Trauma. Ankle Fractures > Annotated References.

[20] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC EXAMINATION AND DEBRIDEMENT OF THE ANKLE JOINT > IMPINGEMENT.

[21] Campbell S Operative Orthopaedics 4 Volume Set. COMBINED HAMMER TOE AND MALLET TOE DEFORMITY WITH ASSOCIATED DOUBLE CORNS > REFERENCES > TARSAL TUNNEL SYNDROME.

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g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.