Ankle Osteoarthritis

Osteoarthritis can affect joints in any part of the body, including the ankle. Three bones make up the ankle joint: the lower end of the tibia (shinbone), the fibula (small bone of the lower leg), and the talus ( the weight-bearing bone that fits into the socket formed by the tibia and fibula).

Early diagnosis and treatment help people with ankle osteoarthritis manage their symptoms.

Osteoarthritis is a degenerative joint disease. With this type of arthritis, cartilage — a tough, but flexible tissue that covers the ends of the bones forming a joint — wears away gradually.

Most cases of ankle osteoarthritis are related to a previous ankle injury. The injury may have occurred years before there is evidence of osteoarthritis in the ankle. Injury can damage the cartilage directly, or it can alter the mechanics of the ankle joint (how the joint works).

Besides injury, there are other risk factors that may contribute to the development of osteoarthritis. Being overweight has been associated with osteoarthritis, and it can add weight to bearing joints, including the ankle. Genetics may also play a role. For example, being flat-footed may affect how you walk and add stress to the ankle joint.

Diagnosis of ankle osteoarthritis usually begins with the patient's medical history. The patient should make her doctor aware of past ankle injuries. A family history of osteoarthritis is also important to note.

A physical examination can reveal an abnormal range of motion in the ankle joint, as well as pain, swelling, or tenderness around the ankle joint. Crepitus (a grinding sound as the joint is moved) suggests the ends of the bones that form the joint are rubbing against each other. During the physical examination, an assessment of bone alignment while walking (gait analysis) may be performed. The analysis also measures the patient's stride and tests the strength of the ankle and foot.

X-rays help determine the severity of ankle damage and can help doctors estimate the amount of cartilage that remains. X-rays or other imaging studies can also detect joint space narrowing and misshapen joints. CT scans or MRIs are used to evaluate ankle joint damage, as well.

The primary symptom associated with osteoarthritis in the ankle joint is pain. Initially, pain is present with movement or activity (walking, climbing stairs, etc.) As osteoarthritis progresses, pain is present even during inactivity or rest.

Other symptoms of ankle osteoarthritis include:

• Joint stiffness
• Joint swelling
• Lost flexibility
• Reduced range-of-motion
• Difficulty walking
• Difficulty with weight-bearing, which may even cause slips and falls

Treatment options for ankle osteoarthritis are usually aimed at controlling pain and limiting motion that provokes the pain. Nonsurgical treatment approaches are tried first. If unsuccessful, surgical options are considered.

Nonsurgical treatment options include:

• Medications (nonsteroidal anti-inflammatory drugs)
• Custom-made rocker-bottom shoes
• AFO (an ankle-foot orthosis or ankle brace)
• Physical therapy
• Dietary supplements (glucosamine and chondroitin)
• Steroid injection into the joint

Surgical options for ankle osteoarthritis include:

• Arthroscopic surgery
• Ankle arthrodesis (fusion)
• Ankle replacement