Ankle Arthritis & Replacement

The ankle is a large hinge joint consisting of three bones: the tibia - commonly referred to as the shin bone, the fibula - the thin bone located next to the shin bone, and the talus - a bone in the foot that sits above the heel bone. The noticeable bony bumps around ankle joint are parts of the base of the tibia (medial or posterior malleolus, located on the inside and back of the ankle respectively) or the fibula (lateral malleolus, located on the outside of the ankle). The primary function of the ankle joint is to enable up-and-down movement of the foot, while the subtalar joint which is located below the ankle joint, allows for side-to-side motion. A strong network of ligaments surrounds the joints and binds the bones together.

Overview

Ankle arthritis occurs when the smooth cartilage covering the ankle joint is partially or completely lost. When this happen, it causes increased blood flow and leads to pain and swelling in the ankle joint and the possible formation of bone spurs. The most common cause of ankle arthritis results from a history of previous ankle trauma such as an ankle fracture which can cause significant loss of cartilage either at the time of injury or over time. Another cause of ankle arthritis is alignment deformity where there is disproportionate pressure on certain areas of the ankle joint that can cause the cartilage to wear out. Alignment deformities are caused by severe flat-feet or high arches or previous fractures to the leg bones. Recurring or multiple ankle sprains can also lead to loss of cartilage and ultimately, cause the individual to develop ankle arthritis. Additionally, inflammatory arthritis such as rheumatoid arthritis or gout can cause severe damage to the ankle joint cartilage, resulting in ankle arthritis.

Symptoms

Individuals with ankle arthritis often have the following sign and symptoms:

  • Ankle stiffness relative to the opposite ankle
  • Noticeable ankle swelling relative to the opposite ankle
  • Noticeable limping
  • Mild or severe restriction in ankle motion
  • Painful cracking or popping of the ankle joint
  • Bone spur

Diagnosis

Significant ankle arthritis can be diagnosed with the use of plain X-rays. The loss of joint cartilage will result in a narrowing of join space that is noticeable in X-rays. Additionally, it's very common for bone spurs to occur which will also be visible in the X-rays. Occasionally, the physician may order a CT scan or an MRI scan to rule out other sources of pain and to determine the proper treatment moving forward.

Treatment

Ankle arthritis can be treated non-operatively as well as operatively. The type of treatment will depend on the patient's symptoms and the extent of the ankle arthritis. The main goal of either approach is to minimize pain and discomfort and ultimately improve function of the ankle joint. Non-operative treatment can successfully decrease symptoms significantly and are often helpful in conjunction with surgery should it be necessary.

Medication - Pain relief medication such as acetaminophen as well as non-steroidal anti-inflammatory medicines (NSAIDs) can significantly reduce pain and swelling.

Physical Therapy - Physical Therapists will often prescribe exercise programs designed to ensure proper function of the ankle joint and the muscles controlling the movement to assist in reducing pain and discomfort. They might even recommend soft, shock-absorbing orthotics shoes with a stiff sole to help disperse some of the pressure applied on the ankle joint and distribute force more evenly.

Durable Medical Equipment - An assistive walking device such as a cane held in the opposite hand can help decrease the force exerted on the ankle joint. In some cases, a brace may be recommended to limit ankle motion.

Weight Loss - For every five lbs. of weight loss there is up to 15 lbs. of force going through the ankle joint, so a reduction in weight is often recommended.

Surgery - Ankle surgery may be an option when more-conservative treatments don't relive ankle pain caused by severe ankle arthritis. Severely damaged ankle joints may require bone fusion or even replacement with the use of an artificial joint:

  • Ankle Debridement - For patients with mild to moderate ankle arthritis, ankle debridement can prove to be very helpful. Ankle debridement is the process of cleaning out the ankle joint by removing bone spurs either arthroscopically or opening up the ankle joint.
  • Ankle Fusion (Ankle Arthrodesis) - This procedure is generally recommended for patients with painful end-stage arthritis where there is very little or no cartilage remaining and can prove to significantly improve symptoms.
  • Ankle Replacement (Ankle Arthroplasty) - This procedure can produce significant pain relief, and when compared to ankle fusion, can result in preservation of motion.
  • Deformities Realignment - In some situations where ankle arthritis is a result of disproportionate distribution of pressure on the ankle joint, especially in younger patients, corrective surgery can aid in alignment in redistributing the load where the cartilage is still preserved.

Recovery

Regardless of the treatment approach taken, patients go through a rehabilitation program which includes physical therapy exercises that are crucial to strengthen your surrounding muscles and ensure proper function of the ankle joint. Each patient is unique, so the treatment and therapy program and duration will vary based on his/her level of pain, severity of the ankle arthritis, and desired level of activity.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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