The concept of ankle joint preserving surgery: why does supramalleolar osteotomy work and how to decide when to do an osteotomy or joint replacement.

The structure of the ankle is stabilized by bone, and external force is distributed to the adjacent intertarsal joints, reducing the vulnerability of the joint to osteoarthritis. Joint-preserving surgical techniques include arthroscopic debridement, ligament reconstruction, distraction arthroplasty, and osteotomy. Supramalleolar osteotomy to treat varus-type osteoarthritis of the ankle is also known as "low tibial osteotomy," as opposed to "high tibial osteotomy" to treat varus-type osteoarthritis of the knee.