Ankle Arthritis Overview

Woman's feet with ankle in black brace

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The ankle joint is affected by arthritis much less often than other joints. When patients have ankle arthritis, they have worn out the tibiotalar joint, which is the joint between the shin bone (tibia) and ankle bone (talus).

Common Causes

Previous ankle injury is the most common cause of ankle arthritis. In people who have sustained an injury such as an ankle fracture, the cartilage may be damaged and this could lead to accelerated arthritis. When the ankle is injured, it is also susceptible to an injury called osteonecrosis. When osteonecrosis occurs as the result of an ankle injury, there is damage to the blood flow to a portion of the bone. Osteonecrosis can also lead to ankle arthritis.

Another cause of ankle arthritis is rheumatoid arthritis. Rheumatoid disease causes joint inflammation and damage to the cartilage. Over time, this can lead to significant problems, necessitating treatment.

Infections of a joint, which lead to damage of the cartilage cells, is another cause. Because cartilage cells cannot regrow, the damage from an infection can last permanently.

Although the effect of genetics on the development of arthritis is not well understood, some people have been observed to have a genetic tendency to wear out joints faster than others.

Body weight is another common factor for ankle arthritis. People who are overweight place a larger burden on their weight-bearing joints—hips, knees, ankles, as well as their feet. They have more of a tendency to develop arthritis, and often have more accelerated damage to the joint cartilage.

Symptoms

Ankle arthritis typically causes pain around the ankle joint, and the most frequent reason for patients to seek treatment is the pain associated with this condition. Other common symptoms of ankle arthritis include:

  • Stiffness of the ankle
  • Swelling around the joint
  • Bone spurs causing a lumpy-looking joint
  • Deformity of the joint
  • Instability, or a feeling the joint may "give out"

Less commonly, ankle arthritis can lead to irritation of the nerves around the joint, causing tingling and numbness in the feet and toes.

Ankle arthritis can easily be diagnosed with an examination and an x-ray. Once patients are diagnosed, nonoperative treatments should be attempted. Most patients can find relief through steps including activity modification and changes in their footwear.

Non-Surgical Treatments

Treatment of ankle arthritis should always begin with simple steps rather than surgery. One of the simplest steps to take is to try some shoe modifications. Cushioned inserts can help alleviate symptoms. Another helpful step is to have a shoe repair specialist add a "rocker-bottom" to the sole of the shoe.

To help support the joint and prevent excessive motion, a brace can be fabricated to help hold the ankle joint in position. These braces are known as ankle-foot-orthoses or AFOs.

Patients should try to limit impact activities including running and jumping. Activity modification like this is an important part of the treatment for ankle arthritis. Patients who are unwilling to change their lifestyle generally should not consider surgical treatments.

In addition to modifications in physical movements, medications can also be an effective treatment. Anti-inflammatory medications can be helpful in patients with moderate symptoms. Patients should use these carefully as there are possible side effects, especially with longer-term use.

Cortisone Injections can be extremely helpful in the management of ankle arthritis, especially in an acute flare-up of pain. While cortisone injections cannot be performed regularly, an occasional shot is helpful in most patients who have ankle arthritis.

Surgical Treatments

If these treatments can't alleviate the ankle pain, then more invasive, surgical treatments may be considered.

Ankle arthroscopy can be useful in patients with limited ankle arthritis, but it is usually ineffective for more extensive ankle arthritis. This type of surgery is most helpful when small bone spurs have developed around the joint causing "impingement," meaning that the bone spur becomes pinched when the ankle moves up and down. During arthroscopic surgery, the bone spur can be shaved to promote the motion of the joint. Unfortunately, if the ankle arthritis is more extensive, this type of surgery will likely be unhelpful. When a significant amount of the cartilage has worn away, the joint will not benefit from such a procedure.

An ankle fusion surgery is the standard treatment for advanced ankle arthritis. This surgery removes the worn-out portion of the joint, and then permanently holds the bones in a solid position.

An ankle replacement surgery is a more controversial treatment for ankle arthritis. While the effectiveness of fusion surgeries is still under debate, there is not too much experience with ankle replacement surgeries. As more of these procedures are being performed, the implant design is being improved. This will likely lead to better results.

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