Ankle articulated distraction is used as a treatment for ankle arthritis. It is based on the theory that osteoarthritic cartilage in the ankle has the ability to heal. Ankle distraction involves the use of external fixation to mechanically unload the ankle joint and prevent contact between the tibia and the talus bones. Arthrodiasthesis involves joint separation as a means to induce healing of the area and optimize the body’s regenerative capacity. For younger patients, this technique may be an alternative to ankle arthrodesis or total ankle arthroplasty.

Indications / Candidacy

Articulated ankle distraction (arthrodiasthesis) is a technique used to treat ankle osteoarthritis, especially in younger patients who experience pain and discomfort because of this condition. Ankle osteoarthritis is generally a progressive condition that may be the result of a high-energy tibial plafond fractures, bimalleolar ankle fractures or recurrent ankle instability.
The ideal candidate for ankle distraction arthroplasty is a motivated patient who seeks an alternative to ankle fusion or total ankle arthroplasty.

Good Candidates for Ankle articulated distraction (arthrodiasthesis) may have:

  • Ankle osteoarthritis (wearing away of the articular cartilage)
  • Pain, decreased range of motion and swelling
  • Hardening of the surrounding bone
  • Damage to the cartilage cells
  • Young age with end-stage osteoarthritis, and are being considered for arthrodesis
  • Failure to respond to more conservative treatment measures

Treated Conditions

The Canadian Limb Lengthening Center offers a team of experienced surgeons, nurses and physiotherapists that make patients feel supported throughout their entire treatment process. Our ability to treat complex orthopedic conditions with a holistic approach gives our patients the best possible outcomes. We pride ourselves in providing highly specialized, expert care. To learn more about ankle arthritis follow the links below:


Ankle arthritis

Surgical Technique

  1. Using an external fixator, the joint is gently re-aligned via the process of mechanical unloading and transferring of weight to the external fixator (metal frame).
  2. Ankle articulated distraction is a minimally invasive surgery that relies on the use of external fixation to pull the joint surfaces apart. An external fixator is a scaffolding assembled around the outside of the leg.
  3. Using pins and wires the frame is attached to the leg while the patient is under anesthesia. The pins are attached to the bones of the ankle and connected to the external frame using wires.
  4. The distraction of the joint is achieved in the operating room by pulling the rings apart and then locking them into place. The frame is built so that the ankle has unrestricted ankle mobility during the distraction, which helps the cartilage heal.
  5. Patients wear the external fixator for approximately 10-12 weeks.


Ankle articulated distraction (arthrodiasthesis) will mechanically unload the ankle to relieve pain, preserve ROM, and potentially delay or even partially reverse the effects of arthritis. Throughout the treatment process regeneration of cartilage increases joint resiliency, stability and orientation while reducing the likelihood of having to undergo more extensive ankle surgeries. If the patient does not achieve satisfactory relief, ankle articulated distraction preserves the bone and joint so that subsequent procedures can still be performed without increased complications.

Potential Complications

As with any surgical procedure, ankle articulated distraction to treat osteoarthritis can have difficulties and complications. In most cases, our team of specialists can address these concerns without compromising the end results or outcome. Complications and side effects may include:

  • Pin infections
  • Abnormal gait due to minimized ankle movement
  • Restricted motion

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre and post appointment dates
  • Make arrangements for personal care givers

Post-Operative Care

The patient starts distraction at a rate of 1 mm per day on postoperative day 1 for a total of 5 days. The goal is to achieve 8-10 mm of distraction. The external fixator is then maintained for 3 months while allowing weight bearing as tolerated. The patient performs daily ankle range of motion exercises and should attend physical therapy three times a week

  • Surgical dressings will be changed 1 week after operation at first follow up
  • Patients can bear full weight during the treatment course
  • Patients are encouraged to do daily range-of-motion exercises
  • Pain medications can be taken to minimize discomfort

Patients who will undergo this procedure should read:

External fixator Immediate post-operative care
Pin site care and infection protocol

Follow-ups after surgery

  • Follow up one week after surgery
  • Consecutive follow-ups every 2 -4 weeks throughout treatment course
  • Attend physical therapy multiple times a week

Case studies

30+ year old female with ankle pain due to non-well healed fracture


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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.