Ankle Arthritis

What is Ankle Arthritis?

Ankle arthritis is a condition characterised by the loss of cartilage in the ankle joint, often developing gradually over several years. This deterioration leads to the narrowing of the joint space between the tibia (shin bone) and the talus (ankle bone), accompanied by the formation of bony spurs (osteophytes). As a result, the ankle becomes painful, stiff, and may produce a grinding sensation or even lock during movement. Though less common than arthritis in the knee or hip, ankle arthritis can be equally debilitating and painful.

There are several types of ankle arthritis, including:

  • Osteoarthritis: This is the most common form, resulting from wear and tear over time.
  • Rheumatoid Arthritis: An autoimmune condition causing inflammation in multiple joints, including the ankle.
  • Post-Traumatic Arthritis: Develops after an injury such as a fracture or severe sprain.
  • Gout: Caused by the accumulation of uric acid crystals in the joint.
  • Haemophilic Arthritis: Occurs in individuals with haemophilia due to bleeding into the joint.

The primary cause of ankle arthritis is previous trauma, such as fractures or severe sprains, leading to joint damage. Other contributing factors include:

  • Age: The risk of developing ankle arthritis increases with age. Over time, the natural wear and tear on the joints can lead to the breakdown of cartilage, which cushions the bones in the joint. As this cartilage wears away, bones begin to rub against each other, causing pain and stiffness.
  • Rheumatoid Arthritis: This autoimmune disorder causes the immune system to attack the synovium, the lining of the membranes that surround the joints. The resulting inflammation can damage cartilage and bones over time. Rheumatoid arthritis often affects multiple joints, including the ankles.
  • Haemophilia: Individuals with haemophilia are prone to bleeding into their joints, including the ankles. Repeated bleeding episodes can lead to inflammation and damage to the cartilage, eventually causing arthritis.
  • Gout: Gout is caused by the accumulation of uric acid crystals in the joint, leading to intense pain and inflammation. These crystals can form when the body produces too much uric acid or fails to excrete it adequately. The recurrent episodes of acute inflammation can cause long-term damage to the cartilage and bones, resulting in gouty arthritis.

The symptoms of ankle arthritis can vary but typically include:

  • Pain: Often worsens with activity and improves with rest.
  • Stiffness: Reduced range of motion, especially after periods of inactivity.
  • Swelling: Around the ankle joint.
  • Grinding Sensation: A feeling of the joint grinding or locking.
  • Deformity: In severe cases, the ankle may appear misshapen.

Anatomy of the Foot

The ankle joint comprises several key structures that are critical to its function and stability. The tibia, or shin bone, forms the upper part of the ankle joint, while the talus, or ankle bone, makes up the lower part. These bones are covered with cartilage, a smooth, rubbery tissue that allows for effortless and pain-free movement. In the context of ankle arthritis, this cartilage deteriorates, leading to bone-on-bone contact, which is a primary source of pain and discomfort.

Ligaments, which are strong bands of tissue, connect the bones and provide stability to the joint. They ensure the proper alignment and movement of the ankle. Additionally, the synovium, a membrane lining the joint, produces synovial fluid that lubricates the joint, facilitating smooth motion. When arthritis sets in, the loss of cartilage combined with possible inflammation of the synovium exacerbates joint stiffness and pain. This degeneration impacts the overall function and biomechanics of the foot, often leading to compensatory changes in gait and posture to alleviate discomfort.

 

Treatment & Surgery Options

For early or mild ankle arthritis, non-surgical treatments can be highly effective in managing symptoms and improving quality of life. One of the first lines of defence includes activity and lifestyle modifications. Patients are encouraged to lose weight if necessary, use walking aids such as a walking stick, and avoid high-impact activities like jumping and running. Instead, low-impact activities such as cycling, swimming, and walking are recommended as they are easier on the joints and can help maintain overall fitness without exacerbating the condition.

 

Medications play a significant role in the management of ankle arthritis. Painkillers and anti-inflammatory medications can provide relief and reduce inflammation if tolerated. Some patients also find that supplements like glucosamine and fish oil are beneficial in managing their symptoms. Physiotherapy is another cornerstone of non-surgical treatment. A physiotherapist can design a tailored exercise program to strengthen the muscles around the ankle, improve flexibility, and enhance overall joint function.

 

Orthotics, or shoe inserts, along with shoe modifications such as rocker-bottom soles and high-cut footwear, can help distribute pressure more evenly across the foot and reduce pain. Ankle bracing or custom-fitted splints provide additional support and stability, which can be particularly helpful during physical activities. In some cases, injections of cortisone or a lubricant like hyaluronate may offer temporary relief from pain and inflammation. However, the response to these treatments can vary widely among individuals, and they are usually part of a comprehensive management plan.

When non-surgical measures fail to provide adequate relief, surgical intervention may become necessary. There are three main surgical options available, each tailored to the severity of the arthritis and the patient’s individual needs and lifestyle.

 

Arthroscopic Debridement is often suitable for patients with early-stage arthritis. This minimally invasive procedure involves inserting a small camera and surgical instruments through keyhole incisions to remove bone spurs and loose bodies within the joint. The recovery period is relatively short, typically around 6 to 12 weeks. However, because the underlying arthritic process remains, the results can vary, and some patients may require further surgery sooner than expected. Approximately 70% of patients experience symptom improvement, though a small percentage may see accelerated deterioration.

 

Ankle Arthrodesis (Fusion) is considered the gold standard for severe arthritis. This procedure involves removing the damaged bone from the tibia and talus and fusing them together with screws. The fusion process eliminates ankle motion, but adjacent joints often compensate, allowing some degree of movement to return. While the procedure is highly reliable for providing long-term pain relief, it can lead to arthritis in adjacent joints over time due to the increased load. A small percentage of patients may require fusion of other joints at some stage in the future. Recovery involves a lengthy rehabilitation period, and potential complications include non-union of the bones and the need for additional surgery in about 10% of cases.

 

Total Ankle Replacement is a newer surgical option, primarily suited for older patients (over 65) with lower physical demands. This procedure involves replacing the damaged ankle joint with a prosthesis consisting of metal components attached to the tibia and talus, and a polyethylene (plastic) bearing in between. Unlike fusion, total ankle replacement preserves some pre-operative ankle motion, which helps reduce the stress on adjacent joints. The recovery period involves regular check-ups and potential maintenance procedures, as the prosthetic joint contains moving parts that can wear out over time. The failure rate is around 2-3% per year, and some patients may eventually require conversion to an ankle fusion. Despite these challenges, approximately 80% of total ankle replacements are still functioning well after 10 years.

 

Each surgical option carries its own risks and benefits, and the best choice depends on various factors, including the severity of arthritis, patient age, activity level, and the presence of arthritis in other joints. A detailed discussion with your specialist is essential to determine the most appropriate treatment plan for each individual.

 

Arthrodesis

Hospital stay 1-2 nights

Rest & elevation 10-14 days

Half-cast / backslab (non-weight bearing) 2 weeks

Full cast (non-weight bearing) 4 weeks

Walking boot (full weight bearing) 6 weeks

Crutches/frame 6-8 weeks

 

Replacement

Hospital stay 2-3 nights

Rest & elevation 10-14 days

Half-cast / backslab (non-weight bearing) 2 weeks

Walking boot (partial-full weight bearing) 6 weeks

Crutches/frame 2-4 weeks

 

Time Off Work

Seated 4-6 weeks

Standing 3 months

Walking well 3 months

Swelling settles 6 months

Final result 12 months

View Specific Treatment Page

Downloadable info sheets related to Ankle Arthritis

These notes from OrthoSport Victoria are for educational purposes only and are not to be used as medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.

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