I have been having pain and swelling intermittently ever since I sprained my left ankle, in October 2006. Following the sprain, I had physiotherapy, followed by orthotics, to prevent overpronation of my foot and ankle. For a while, I developed peroneal tendinitis, which eventually subsided. I persevered with the orthotics for some time, but they never really seemed to help, so I gave up wearing them (they were hot, uncomfortable and ugly). My ankle pain and swelling have increased over the past couple of years, to the extent that I decided to find out what was really going on. Much of my pain and swelling is inferior and slightly anterior to the lateral malleolus, with a very tender lump over the malleolus. Symptomatically, I also feel that I am developing arthritis in both feet. Following an inconclusive X-ray of my left ankle, my GP referred me back to my OS, who ordered an MRI, which I had last Thursday. (The radiologist reported nothing significant, but my OS showed me several places where he could see narrowed joint spaces, indicating arthritis.) I saw my OS this afternoon. He discussed my X-ray and MRI with me, showing me various things on his screen. I could see narrowed joint spaces and that there is some deterioration of the talus and navicular bones – on the MRI pictures, part of them looked white, with small cysts, instead of the clear black of the rest of the bones. This is the MRI report (I don’t have pictures, unfortunately): MRI Left Ankle 31 March 2016 Indication: Painful swollen left ankle. Probable arthrosis. Confirm severity of chondral changes. Technique: Standard MRI ankle protocol. Findings: There is a generalised ankle oedema, slightly more pronounced laterally and anteriorly. There is thinning of articular cartilage of the tibiotalar joint with resulting joint space loss and subchondral oedema medial talar dome. There is also mild subchondral oedema of the distal fibula and more pronounced subchondral oedema with cyst formation around the intertarsal articulations, particularly medial facet of the subtalar joint which also shows thinning of articular cartilage and resulting joint space loss. There is osteophytic lipping of the talonavicular joint associated with capsular hypertrophy. Further osteophytic lipping is also noted between the remaining intertarsal articulations. Appearances are consistent with arthrosis. Lesser amount of subchondral oedema and subchondral cyst formation is noted of the first, second and third tarsal-metatarsal joints associated with osteophytic lipping and moderate chondral thinning and joint space loss. The ligament and tendons of the left ankle are grossly intact except for the anterior and posterior talofibular ligaments which are attenuated and indistinct, suggestive of partial tearing if there has been a history of trauma. There is a 12 x 9 x 11 mm. fluid signal intensity structure anterolateral to the talus (7/8) which may represent a small ganglion cyst. The very distal peroneus brevis and longus tendons are suboptimally visualised, likely related to magic angle artefact rather than pathology. Clinically correlate. The sinus tarsi demonstrates normal fat signal intensity. There is a small calcaneal plantar spur but no evidence of plantar fasciitis. Fluid is noted around the flexor halluces longus tendon, of doubtful clinical relevance. Impression: Significant arthrosis of the left ankle with thinning of articular cartilage and joint space loss, osteophytic lipping and significant subchondral bone marrow oedema and cyst formation. Indistinct and attenuated anterior and posterior talofibular ligaments are suggestive of partial clearing if there is a history of trauma. Generalised soft tissues oedema of the left ankle which is more pronounced laterally. Underlying inflammatory arthropathy not excluded. Small ganglion cyst. At this appointment, I was only wanting to establish the cause of my continuing pain – not expecting that there would be any immediate treatment. I admit that I suspected some mild degree of arthritis, but I thought my intermittent but recurring pain was probably tendinitis. I was wrong. The ganglion probably accounts for the painful lump over the malleolus. My OS has suggested that, as this degree of pain is currently “liveable”, no surgical treatment is warranted right now. We discussed having a steroid injection into the sinus tarsi, but he said this would only give temporary relief and probably wasn’t worth-while. I can’t have NSAIDS, because of my bleeding disorder. If the pain persists and gets much worse, the surgical option would be a subtalar fusion (including talo-navicular fusion) which would eliminate lateral movement of my ankle, but would not restrict dorsiflexion or plantar flexion. Meanwhile, my OS has recommended a UCBL type orthotic (rigid heel cup with medial arch support), to restrict lateral movement of my ankle. On the request form for the orthotic, he has put the diagnosis as “Post traumatic arthrosis left subtalar joint.” We’re sticking with “post traumatic" for now, as I still have a claim with ACC (Accident Compensation Corporation) relating to the original accident and ACC has covered my costs so far. My OS said “Try the orthotic for a while. It may help. If it doesn’t, come back and see me and I’ll refer you to my colleague for the fusion.” He specialises in knees and hips, could do the fusion but prefers it to be done by someone whose specialty it is. @Josephine , @Orthodoc , I’d welcome your opinion here, particularly with reference to the recovery period and success rate of subtalar fusions. I know that non-union is sometimes a problem. Thank you.