X-ray of ankle osteoarthritis

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Author: Mikael Häggström [notes 1]

Planning

Weight-bearing radiography

Evaluation

The Kellgren-Lawrence scale has been recommended,[1] but in practice it is generally acceptable to give the degree as mild/moderate or severe.

Kellgren-Lawrence system
Grade Description
0 No radiographic features of osteoarthritis
1 Osteophyte formation and possible joint space narrowing. The normal distances between the bones in the ankle are as follows:[2]
  • Talus - medial malleolus : 1.70 ± 0.13 mm
  • Talus - tibial plafond: 2.04 ± 0.29 mm
  • Talus - lateral malleolus: 2.13 ± 0.20 mm
2 Definite osteophyte formation with possible joint space narrowing
3 Multiple osteophytes, definite joint space narrowing, sclerosis and possible bony deformity
4 Large osteophytes, marked joint space narrowing, severe sclerosis and definite bony deformity

Varus or valgus

Varus or valgus deformity, if suspected, can be measured with the frontal tibiotalar surface angle (TTS), formed by the mid-longitudinal tibial axis (such as through a line bisecting the tibia at 8 and 13 cm above the tibial plafond) and the talar surface.[3] An angle of less than 84 degrees is regarded as talipes varus, and an angle of more than 94 degrees is regarded as talipes valgus.[4]

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. Nicolas Holzer, Davide Salvo, Anne Karien Marijnissen, Aminudin Che Ahmad, Emanuele Sera, Pierre Hoffmeyer, Anne Lübbeke Wolff, Mathieu Assal (2017-09-14). "How to assess ankle osteoarthritis: comparison of the Kellgren and Lawrence scale with functional outcome and digital image analysis ". Orthopaedic Proceedings 94-B. Archived from the original. . 
  2. Imai, Kan; Ikoma, Kazuya; Kido, Masamitsu; Maki, Masahiro; Fujiwara, Hiroyoshi; Arai, Yuji; Oda, Ryo; Tokunaga, Daisaku; et al. (2015). "Joint space width of the tibiotalar joint in the healthy foot ". Journal of Foot and Ankle Research 8 (1). doi:10.1186/s13047-015-0086-5. ISSN 1757-1146. 
  3. Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat (2012). "The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles ". Skeletal Radiology 41 (12): 1567–1573. doi:10.1007/s00256-012-1421-6. ISSN 0364-2348. 
  4. T.L. Nosewicz (2018-09-25). Acute and chronic aspects of hindfoot trauma . University of Amsterdam, Faculty of Medicine (AMC-UvA). ISBN 9789463750479.