Management of recurrent medial ankle pain after total ankle replacement arthroplasty: the role of medial malleolar anterolateral corner resection in resolving bone-to-implant impingement

A male patient in his early 70s presented with persistent medial ankle pain after total ankle arthroplasty. Despite an initial revision for osteophyte debridement, symptoms recurred due to dynamic bone-to-implant impingement. A second revision involving triple Achilles hemisection and strategic resection of the medial malleolar anterolateral corner was performed to create structural clearance. At 4.5-year follow-up, the patient reported dramatic pain relief and significantly improved functional scores (Foot and Ankle Ability Measure-activities of daily living: 92.9%). When simple osteophyte debridement fails, strategic partial resection of the medial malleolar anterolateral corner results in resolution of symptoms in this case, leading to improvement in functional outcomes by restoring necessary mechanical clearance. Ensuring adequate mechanical clearance between host bone and prosthesis is crucial for successful long-term outcomes.