ankle pain - Ankle arthritis

Ankle Anatomy

The ankle is comprised of four main bones: the tibia, fibula, talus, and calcaneus. The connection of the tibia and fibula with the talus creates the Talocrural joint. This is the joint most people think of as the ankle joint. This joint allows the foot to move up and down. Another joint is formed between the talus above and the calcaneus below. This is called the Subtalar joint and allows the joint to move side to side. Together these joints also allow the ankle to pronate and supinate. Like all joints, each bone is lined with a thin layer of cartilage called articular cartilage. Damage to this cartilage can expose the underlying bone, causing inflammation of the joint. This inflammation of the joint is what is referred to as arthritis.

Causes of Ankle Arthritis

Primary ankle arthritis is rare and often can be misdiagnosed. However there is usually an underlying cause that has instigated arthropathy of the ankle.

These are usually;

Trauma

Damage to the ankle joint or surrounding bones such as in a sporting injury or road traffic accident can cause damage to the ankles cartilage. This in turn leads to erosion and associated wear and tear within the joint. Trauma is usually (but not always) associated with a fracture of one or all of the bones connected with the ankle joint complex.

Systemic

Disease that attack joint surfaces such as rheumatoid arthritis, psoriatic arthropathy, gout etc can lead to ankle arthritis.

Infection

Infection can lead to septic arthritis. This can be caused by direct transmission through the skin but in rare cases can originate from another part of the body. Sexually transmitted diseases can also lead to arthritis which can affect the ankle

Mechanical stress

Mechanical stress caused by external factors such as obesity or a profession/ sporting activity that puts excess pressure on the ankle can lead to arthritis within the ankle joint. However this is a gradual process which occurs over many years. Stresses within the ankle can be significantly reduced by altering the negative biomechanics within the ankle using orthotics.

Symptoms of ankle arthritis

Can include one or more of the following;

ankle joint pain with walking and stair climbing

joint clicking or catching

As inflammation increases, redness and swelling can occur.

The loss of normal range of motion can also be noticed in advanced arthritic conditions.

Conservative treatment of ankle arthritis

Pain relievers and anti-inflammatory medications to reduce swelling

Shoe inserts (orthotics), such as pads or arch supports

Custom-made shoe, such as a stiff-soled shoe with a rocker bottom

An ankle-foot orthosis (AFO)

Ankle brace

Physical therapy and exercises

Weight control or nutritional supplements

Steroid medication injected into the joint

Surgical treatment of ankle arthritis

Arthroscopic Debridement

A debridement for ankle arthritis is useful in the earlier stages of the arthritic process. It is normally performed as a day case procedure and generally patients can weight bear straight away on the operated ankle. The success rate for the procedure is in the region of 75%-80%. This corresponds to the percentage chance of improvement but not complete symptom resolution. On occasion it can take a number of months before this benefit is achieved. It needs to be borne in mind that there is approximately a 5% chance of significant symptomatic worsening following debriding an arthritic ankle.

Ankle Fusion

Ankle fusion involves preparing both sides of the joint back to healthy and bleeding bone. The arthritic joint lining is removed and the ankle joint is placed in a functional position and held there until the bone has grown across the joint and the ankle is thus fused. The ankle is held in position whilst the fusion is occurring and this is most commonly done with large screws which are buried beneath the skin. Occasionally a large metal rod may need to be inserted through the heel to compress the ankle and sub-talar joints (known as a double fusion). In cases where infection is present a device known as an Ilizarov frame may be used to compress the ankle joint and hold it in position until fusion has occurred. On average it takes three months for bone to be fairly soundly fused but on occasion it can take significantly longer.

Ankle Replacement

Ankle replacement involves replacing the two worn out surfaces with replacement highly polished surfaces and adding a high molecular weight polyethylene spacer between the two surfaces. Ankle replacement generally maintains the range of movement which a patient has pre-operatively. It is not suitable for heavy manual or sporting activities and probably has a ten year life span.

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