Ankle Arthritis

Ankle arthritis leads to pain and swelling in the ankle joint. Symptoms are often aggravated by standing and walking and patients often walk with a limp. Ankle arthritis commonly results from a history of trauma to the ankle, either a severe ankle injury such as a bad ankle fracture, or a series of recurrent injuries to the ankle. However, it may develop from other causes such as uneven loading of the ankle joint due to an alignment deformity; inflammatory arthritis such as rheumatoid arthritis; crystal arthritis such as gout, or secondary to a serious joint infection.

Patients with severe ankle arthritis will often have limited ankle motion and may have a grinding sound when they move their ankle joint. Ankle arthritis is commonly associated with loss of cartilage from the ankle joint which will show up on a weight-bearing ankle x-ray. Non-operative treatment is designed to improve function and decrease pain and is based on: limiting the amount of loading through the ankle joint (weight loss, activity modification, cane, etc.); masking the symptoms (anti-inflammatory medication, pain medications); and decreasing ankle joint movement (ankle bracing, rocker-bottom shoewear).

Operative treatment may be helpful if non-operative treatment is unsuccessful. Common operative treatments include cleaning out (debriding) the ankle joint if the ankle arthritis is not severe or ankle fusion for patients with severe arthritis. Ankle replacement may be an option for older patients who are not excessively active.

Ankle pain, stiffness and swelling are characteristic symptoms of ankle arthritis. Pain is often aggravated by activities such as standing and walking. “Start-up” pain such as when a patient has pain and stiffness in the ankle after sleeping or sitting in one spot for a while is also a common complaint. When this occurs it often takes the patient a few minutes (or longer) to “warm-up” the ankle. The ankle will tend to swell more as the day progresses particularly if there is increasing activity. Pain is often experienced throughout the ankle although it may be more noticeable if the front of the ankle if large bones spurs have formed.Ankle arthritis occurs when there has been damage to the joint cartilage that normally covers the bones of the ankle joint. Loss of cartilage leading to ankle arthritis can occur from a variety of causes including:

• Major ankle trauma (such as an ankle fracture)
• Many small to moderate recurrent injuries to the ankle joint over time (such as occurs in ankle instability)
• Abnormal ankle joint loading
• Inflammatory arthritis
• Crystal arthritis
• Infectious arthritis
• Physical Examination

On physical examination patient will often have ankle swelling relative to the opposite ankle. There is likely to be a restriction in ankle motion which may be associated with cracking or popping. Patients may walk with a noticeable limp.

Imaging Studies

Ankle arthritis can be diagnosed on plain ankle x-rays. X-rays performed with the patient weight bearing will demonstrate:

• Loss of joint space
• Bone spurs
• Bone whitening at the joint line

In subtle cases or if their are other questions that need to be answered it may be necessary for the treating doctor to order an MRI or a CT Scan of the ankle and hindfoot.

Treatment

There is non-operative and operative treatment for ankle arthritis. The goals of treatment are to minimize pain and discomfort and improve function. The type of treatment will depend on the patient’s symptoms and the extent of the ankle arthritis. Often non-operative treatment can be successful in significantly decreasing symptoms. Many of the non-operative treatment approaches can also be helpful in conjunction with surgery.

Non-Operative Treatment

There are a variety of non-operative treatments. These treatments are designed to:

1. Limit the force going through the ankle joint;
2. Limit the movement through the ankle joint and/or;
3. Minimize the pain response.

Non-operative treatments may include:

• Anti-Inflammatory Medication (NSAIDs)
• Acetaminophen
• Glucosamine Sulfate
• Hyaluronic Acid Injections
• Comfort shoes with a stiff sole and a rocker-bottom contour to disperse the force more evenly past the ankle
• Ankle lacer (or boot) to limit ankle motion
• Cushioned shock absorbing orthotic
• Cane used in the opposite hand to decrease the force that is loaded through the ankle joint with each step.
• Weight loss
• Physiotherapy or Home exercise programs
• Activity modification

Operative Treatment

In certain patients with ankle arthritis surgery may be beneficial. Surgical options include:

• Ankle Debridement
• Ankle Fusion (Ankle Arthrodesis)
• Ankle Replacement(Ankle Arthroplasty)
• Realignment of Deformities