Ankle Arthritis

Overview

Ankle arthritis occurs when there is a breakdown of cartilage in the ankle joint.  This breakdown of cartilage can be due to multiple reasons to include history of trauma, autoimmune diseases such as rheumatoid arthritis or infection.  In most cases, arthritis is due to loss or degeneration of the cartilage from an old injury.

Symptoms

  • Pain that may increase with activity
  • Stiffness or loss of mobility
  • Swelling
  • Deformity of ankle may be present

Evaluation

During your office visit you can expect for the following to occur to better understand your discomfort.

  • X-rays: X-rays will be taken to evaluate the degree of arthritis present and any associated ankle deformity.
  • Complete history and physical examination of the ankle to assess for skin changes, presence or absence of pulses and nerve sensation, range of motion of the ankle and areas of discomfort.
  • Further testing such as a CT or MRI may be ordered to more clearly define the ankle anatomy for pre-surgical planning.

Treatments

Both non-operative and operative treatments will be discussed with you.  A treatment plan will be formed based on prior interventions, current level of disability and presence of other medical conditions.

Non-Operative treatment:  Non-operative management is always the first line of treatment, especially if no other interventions have been prescribed.  This can include:

  • ankle bracing (either custom or pre-fabricated)
  • cortisone injections
  • activity modifications, ice and anti-inflammatory medications

Operative treatment: If non-operative treatment has failed, then surgical intervention may be the next reasonable step.  Depending on patient’s symptoms and severity of arthritis, surgery can include one of the following:

  • Debridement or removal of bony osteophytes or spurs either through an open ankle incision or through an ankle scope (arthroscopy).
    • Debridement may not be an option if the arthritis is moderate or severe.
  • Ankle fusion (arthrodesis): In an ankle fusion the two bones that make up the ankle joint, the tibia and talus, are fused together to make one solid block of bone.
    • Risks and benefits
      • Excellent pain relief
      • Correction of any ankle deformity
      • 90% fusion rate on first attempt
      • Fusion of the ankle does result in loss of approximately 75% of ankle motion; however, some motion is retained through the joints underneath the ankle and into the midfoot.
      • Surrounding joints may develop arthritis due to increased load after ankle fusion
    • Surgical procedure
      • Inpatient or outpatient
      • Usually involves general anesthesia
    • Post-Operative Care
      • Patient is non-weight bearing for at least 6 weeks post-operatively in a splint or cast
      • Sutures are removed 2 weeks post-operatively
      • Once weight bearing is initiated, it will be a cast or boot for an additional 6 weeks.
      • At 3 months post-operatively, patient is transitioned into a shoe with an ankle brace.  Non-impact activities can be initiated at this time.
    • Long-Term Expectations
      • It may take a full year to reach maximal medical improvement in regards to swelling and becoming accustomed to functioning with a fused ankle.
      • Gait: gait may be slightly slower with shorter steps
      • Recreational activities: patients should be able to engage in non-impact activities such as walking, biking, hiking and swimming with little discomfort. Higher impact activities and work from heights may not be recommended.
  • Total Ankle Replacement (arthroplasty)
  • Distraction arthroplasty: a novel technique using an external frame to distract the ankle joint while maintaining motion.
    • Currently there is limited evidence on the success of this treatment.