Preoperative planning and surgical technique: how do I balance my ankle?

Ligament balancing during total ankle arthroplasty is an important step in optimizing the mechanical balance of the ankle joint. Soft-tissue contractures that result from varus or valgus coronal plane deformity can pose a difficult problem, and the surgeon should have a standard procedure for managing such situations in the operating room. Balance may be assessed intraoperatively with the use of spacer blocks, laminar spreaders, and tensioning devices as well as by placement of trial components. Techniques used to balance the varus or valgus ankle during primary total ankle arthroplasty include osteophyte resection, soft-tissue release, and bone resection. Mediolateral ligament balancing is crucial for long-term success and patient satisfaction.