Ankle arthritis is a painful condition that can place extreme limitations on your lifestyle. The word arthritis, when broken down, simply means "inflammed or painful joint" (arthro- "pain", itis- "inflammation"). Unlike arthritis of the knee, ankle arthritis rarely occurs just from "wear and tear." It is usually related to some kind of trauma or systemic arthritis. There are multiple stages of arthritis
Stages of Arthritis:
- Mild - Isolated Inflammation and Pain. No Cartilage damage. Pain improves with rest.
- Moderate - Cartilage damage begins and worsens. Pain is more consistent and intense. Stiffness increases. Bone Spurs start to form.
- Severe (End-Stage) - Cartilage is destroyed. "Bone-On-Bone." Bone Spurs increase in attempt to limit, and eventually stop, joint motion. Pain is unbearable, leading to marked decrease in activity level.
One of the major goals of the evaluation is to classify the arthritis into the stage of severity. This involves identifying pain level and activity limitations, in addition to assessing range of motion. It is of extreme importance to evaluate for any instability or deformity of the foot, or lower leg, that may be a cause of increased strain on the joint. It is also important to evaluate the Subtalar joint (joint beneath the ankle), as both joints may be affected. X-rays are routine. Diagnostic/Therapeutic Injection can help predict the success of certain treatment options. CT scan or MRI can be useful in staging the arthritis, and it is helpful in pre-operative planning.
Conditions That Can Lead To Ankle Arthritis:
- History of Ankle Fracture
- Ankle Instability
- Osteochondral Lesion of Talus (OLT)
- Rheumatoid Arthritis
- Deformity of the Foot or Ankle
- Degenerative Arthritis
The available treatments depend greatly on what stage of arthritis you have. It is important to remember that arthritis will get progressively worse with time, and treatment is centered around managing the symptoms and trying to prevent major activity limitations, until you reach the point where surgery is necessary.
- Mild arthritis can generally be managed with oral or topical anti-inflammatory medication, and periodic steroid injections may be beneficial. Physical therapy may also be indicated.
- Moderate arthritis usually requires periodic steroid injections for pain relief, with use of daily anti-inflammatory medication. Bracing or Ankle-Foot-Orthosis (AFO) options may be considered at this stage.
- End Stage Arthritis often requires reconstructive surgery. Surgical options include joint fusion and joint replacement. Custom AFOs can be used as a non-surgical option, but required a lifelong commitment to wearing the brace, and can be limiting to shoe options. Oral, topical, and injectable medications are used as needed to manage pain.
Arthroscopic Surgery can be utilized in mild or moderate arthritis. The goal of arthroscopy is to clean out inflammation inside the joint, remove any bone spurs that may start to form, and identify the level of cartilage damage. Arthroscopic surgery does not cure the arthritis, rather it is a minimally invasive procedure that substantially decreases painful symptoms and may delay the need for extensive surgery by several months or years.
Bone Spur removal can be performed through arthroscopy; however, if severe spur formation exists, open surgery may be use to remove spurs in an attempt to delay fusion or replacement of the joint.
Ankle fusion is the Gold Standard procedure for end-stage ankle arthritis. It has been used for decades, with high predictability. One major concern patients have about fusion surgery is that the joint will no longer move. In most cases of severe arthritis, the joint has very little or no motion before surgery, anyways! So by fusing the joint, you are generally not decreasing that much motion, but you are eliminating the excruciating pain involved with the small amount of motion that was remaining.
Ankle joint replacement involves using an implant to try and recreate the joint, allowing for some motion at the joint. There are some age, activity level, and other criteria that must be met in order to be considered a candidate for ankle replacement. Generally, patients do not gain "normal" range of motion after joint replacement, but they do gain significant, and pain-free, motion of the joint. There can be an increased chance for further surgery needed or complications, when comparing ankle replacement to ankle fusion, but, for some patients, joint replacement is the best surgical option.
If you have pain from Ankle Arthritis, Call us at 512-593-2949 or CLICK HERE to Schedule an Appointment.