Management of Painful Malleolar Gutters After Total Ankle Replacement

  • Bernhard Devos Bevernage
  • Paul-André Deleu
  • Harish V. KurupEmail author
  • Thibaut Leemrijse


Total ankle replacement is a technically challenging procedure that has the potential to restore a pain-free, mobile, and stable ankle. Despite high satisfaction rates reported in the literature, patients complaining about malleolar gutter pain range from 2 to 23.5 % between various total ankle replacement prostheses and ankle arthritis etiologies. The exact cause has not been fully understood and appears to be multifactorial. However, recent literature reports that malleolar gutter pain is often a sign of overloading caused by malalignment of the hindfoot and the ankle or by malpositioning of the total ankle replacement components. Therefore, detailed clinical and radiographic assessment is essential to identify the incriminating factors provoking the malleolar gutter pain. These factors should always be addressed in association with debridement of the malleolar gutters in order to prevent recurrence of the patients’ symptoms. The present chapter explores the potential inciting factors of the gutter pain after total ankle replacement and how they can be managed.


Arthroplasty Complications Gutter impingement Malleolar gutter pain Total ankle replacement 


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Bernhard Devos Bevernage
    • 1
  • Paul-André Deleu
    • 1
  • Harish V. Kurup
    • 2
    Email author
  • Thibaut Leemrijse
    • 1
  1. 1.Clinique du Parc Léopold, Foot and Ankle InstituteBrusselsBelgium
  2. 2.Department of OrthopaedicsPilgrim HospitalBostonUK

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