Total Ankle Replacement Surgery

Total Ankle Replacement Surgery available now in Sarasota & Bradenton, FL

Ankle joint replacement is emerging as an alternative to fusion in the surgical treatment of severe ankle arthritis. Restoring normal ankle joint function through a replacement can result in a reduction of pain and lead to a more normal walking cycle. Unlike the knee and hip, which are prone to develop primary osteoarthritis, the ankle usually develops arthritis because of a traumatic event such as a fracture or long standing instability due to a severe sprain.

The primary indications for a total ankle replacement are primary osteoarthritis, post-traumatic arthritis as well as rheumatoid arthritis in those patients who have failed conservative treatment.

Studies are demonstrating that the results of ankle replacement are very good and the outcome from a functional standpoint, are actually better than a fusion. With a fusion the ankle joint is glued together and the up and downward motion is lost. An implant will allow that motion to continue and will lead to better function of the joint. This movement is important for walking, exercising as well as routine activities of daily living.

 Patient selection is critical with respect to the overall success and long term longevity of a total ankle replacement. The surgeon must take into account the age of the patient, weight, activity level, quality of bone as well as co-existing deformities when considering an ankle replacement. Not all patients with arthritis of the ankle are candidates for an implant and a different type of procedure may be a better option. All possible treatments for ankle arthritis can be explored in a short visit in the office with Dr. Cottom.

Dr. Cottom has extensive experience with total ankle replacements being involved in hundreds of cases over the last 8 years including revising implants that have been placed by other surgeons. He is the only fellowship trained foot and ankle surgeon who is certified on all 5 FDA approved total ankle implants in the region. Furthermore, Dr. Cottom has implanted more total ankles than any other surgeon in the region with excellent results to date. Patients no longer have to live with debilitating pain due to ankle arthritis and in select patients, a total ankle replacement may be an excellent option. Please feel free to contact him at Florida Orthopedic Foot & Ankle Center 941-845-0233 to determine if you are a candidate for this type of procedure.


The bony anatomy of the ankle joint helps determine the planes and range of joint motion and allows for a high degree of stability when the joint is loaded during the walking cycle. The three bones that form the ankle joint are the tibia, fibula, and talus which all support three sets of opposing articular (joint) surfaces.

The bony anatomy, ligaments, and joint capsule guide and restrain movement within the joint. The talus has a continuously changing axis of rotation as it moves from maximum dorsiflexion (upwards motion) to maximum plantar flexion (downwards motion) relative to the mortise. The talus and mortise widen slightly from posterior (back) to anterior (front). In most normal ankles, the soft tissue structures, including joint capsule, ligaments and muscle tendon units that cross the joint, prevent significant translation of the talus relative to the mortise.

ankle joint movementThe bone ends of a joint are covered with a smooth material called cartilage. The cartilage cushions the bone and allows the joint to move smoothly without pain. Arthritis occurs when there is deterioration or destruction of joint cartilage. The normal smooth lining of a joint surface becomes rough and irregular, which causes pain. Unfortunately, the body cannot repair the damaged cartilage. Arthritis can occur at any joint in the foot and ankle region, although the ankle joint itself is most commonly affected.ankle x-ray

There are different types of arthritis, including osteoarthritis, rheumatoid arthritis, and post-injury (or post-traumatic) arthritis. Osteoarthritis (OA) is partly due to a familial tendency, and partly an inherent consequence of aging. People usually begin feeling the effects of osteoarthritis in their 60’s. Rheumatoid arthritis is characterized by joint inflammation affecting numerous joints, and often begins at a young age. As the name implies, post-injury arthritis occurs as a result of a single or recurrent injuries to a joint surface such as fractures or sprains.

Treatment Options:

The severity of the condition, extent of pain and the ability of the patient to tolerate walking with a painful stiff ankle determine the treatment of ankle arthritis. Like most other forms of arthritis, conservative treatment is initiated first. This can be done in the form of rest, immobilization of the ankle joint, arthritis medication and in some cases an injection of cortisone into the joint. The success rate of the surgery is the same, whether the surgical procedure is performed promptly upon diagnosis or years later.

 Implant Options:

Currently there are 7 total ankle replacements that are approved by the Food and Drug Administration (FDA) in the United States. Dr. Cottom is the only foot and ankle surgeon in the region who is certified to use all 7 implants. After a detailed exam in the office the appropriate implant will be selected if the patient is a candidate for an ankle replacement.


Salto® Talaris Total Ankle Replacement is a 3 piece implant with mobile bearing instrumentation that is designed to reproduce the natural flexion and extension of the ankle with an anatomic design.


Salto Talaris XT Revision Total Ankle Replacement is a new revision system that was released in early 2014.  It allows for revisions to be performed of Salto Talaris implants as well as other implants.  Dr. Cottom has revised many implants with this new system with excellent results to date.  In addition, this implant works very well with takedown fusions.  In select cases it may be possible to revise a previous fusion to a total ankle.  Dr. Cottom has experience with this complex procedure and is willing to talk with potential patients about this type of procedure.


Inbone™ Total Ankle Replacement is a three piece implant that consists of a long tibial stem which anchors the implant into the tibia.


The Agility™ LP Total Ankle Replacement is a fourth generation design that is based on over 20 years of clinical experience. The Agility™ LP Total Ankle Replacement


The Zimmer Trabecular Metal Total Ankle is designed to restore alignment, reduce pain and preserve the flexion and extension movement of the ankle. This implant is inserted laterally. The Zimmer Trabecular Metal Total Ankle


Integra® Cadence® Total Ankle System

Integra® Cadence® Total Ankle System 1Integra® Cadence® Total Ankle System 2

The Integra Cadence Total Ankle System is designed to treat ankle arthritis through replacement of the ankle joint with a prosthesis, thereby reducing pain, restoring alignment, and allowing for movement at the replaced joint.

The prosthesis is composed of a tibial tray, a talar dome and an insert. Both the tibial tray and talar dome are secured to patient anatomy; the insert is rigidly fixed to the tibial tray intra-operatively. When all three components are implanted, the insert acts as a bearing along the talar dome, enabling flexion and extension movement at the replaced joint.

Each of the three components is available in a variety of sizes and design configurations intended for both primary surgery and revision surgery applications.

For more information on FLOFAC’s participation in an international clinical study, please visit

Patient Testimonials:

This is a letter of gratitude to Dr. James Cottom, he performed ankle replacement surgery on my left ankle on 7/6/10, the consultation was very through and his resume is impeccable, the surgery was a complete success and I would highly recommend him for any person needing such surgery. I have full mobility and lead an active life. His staff was wonderful, they returned my calls in a timely matter.


Ann M. 66 years old Venice, FL

I broke my ankle 3 times while playing college sports. Over the years my ankle deteriorated making it very painful to walk. After much research on the internet and consulting Orthopedic Surgeons, I found Dr. Cottom who performed ankle replacement surgery. His pre and post surgery care have been superb. I especially like the conservative approach taken for the healing process before beginning rehab. I would rate my care by Dr. Cottom and his staff as excellent.


Robert Murphy Sarasota, FL

After 10 years of painful suffering from dysfunctional arthritic pain in my left ankle, I began a search for a medical professional who was on the cutting edge of orthopedic medicine hoping to find someone with good news and a promise of relief. Following several visits to podiatrists, who could not fix the problem, I found my way to Dr. James Cottom. Dr. Cottom was straight forward and thorough in his exam. After a number of testing procedures, Dr. Cottom determined that there was significant help available and I was a candidate for a complete ankle replacement. Dr. Cottom, a highly gifted and skilled surgeon, performed complete ankle replacement surgery on me on the 15th of February 2011. Fourteen weeks after surgery I progressed to where I had no pain, was walking normally and now I’m looking forward to many years of enjoyable mobility. My extravagant thanks to Dr. James Cottom for using his superior gifts to help those in need.


Rev. Neal S. Busker Venice, FL