Basics of ankle arthritis
Ankle arthritis is a clinical condition in which the joint that connects the foot to the leg, known as the tibiotalar or ankle joint, has damaged or worn out cartilage. There are three bones involved in this joint: the tibia, the fibula and the talus. The arthritis can involve any or all of these bones. Arthritis is characterized by pain and swelling.
Immediate medical attention
There are a few medical emergencies with ankle arthritis. Generally this is a chronic condition. If the ankle locks into position and will not move, it may be that a piece of bone is trapped in the joint. This would require immediate medical attention. If the ankle is hot and swollen, infectious arthritis may be present and immediate evaluation is needed.
Facts and myths
It is not widely known that arthritis can affect the ankle. The ankle is much less likely to be involved with arthritis than the hip or knee. The ankle is less often involved in osteoarthritis. However, arthritis does affect the ankle. It is likely to be involved in inflammatory arthritis such as rheumatoid arthritis. It is also often involved in the arthritis that occurs after injury.
Bruce J. Sangeorzan, M.D. UW professor and chief of Harboview Orthopedic Service and Traumatology and Dr. Sigvard Hansen, M.D., UW professor and director of Sigvard T. Hansen Foot and Ankle Institute discuss surgical options and the outcomes of treatment for ankle arthritis.
Total Ankle Part 1
Total Ankle Part 2
Total Ankle Part 3
Although not life-threatening, ankle arthritis can significantly limit one's ability to participate in recreational activities, workplace activities and at times, activities of daily living.
Pain is a common component of ankle arthritis. It is located in the area of the ankle joint and is affected by the level of activity.
There are numerous treatment options for ankle arthritis. The treatment will depend on the type of arthritis and the unique characteristics of the affected person. Things such as age, weight, type of work, recreational activities and general health will affect the treatment.
While ankle arthritis does not cause direct metabolic changes, it may affect the way one walks which may consume more energy than the person’s normal walking style. This might create a sense of fatigue.
There are no known dietary components linked directly to ankle arthritis. A healthy well-balanced diet that contributes to overall health helps to improve any chronic condition. In addition, the ankle joint is small and body weight is concentrated in the small joint surface. Small reductions in overall body weight may have a significant impact on the stress on ankle joint. Weight reduction in general improves the comfort of a joint that bears weight.
Ankle arthritis may occur from wear and tear as part of a systemic arthritis, such as rheumatoid arthritis or as a result of an injury. The deformity in limb may contribute to excessive wear and tear and early onset of arthritis. For example, repeated ankle sprains that result from the foot deformity could lead to arthritis.
Only in very rare incidents is ankle arthritis the result of infection. Even then, it is highly unlikely to be contagious.
Lifestyle risk factors
There is some evidence that a high level of recreational participation in sports is associated with a higher incidence of ankle and foot arthritis. The exact risk factors are not well known.
Injury & trauma risk factors
Ankle arthritis is commonly associated with prior fracture of the ankle or any of the bones that make up the ankle joint. It also seems likely that repeated sprains of the ankle may lead to ankle arthritis over time.
Ankle arthritis may affect any of the three bones that make up the ankle joint: the tibia, the fibula and the talus. The talus is a small but important bone that connects the foot to the leg.
Pain and swelling are the key warning signs of ankle arthritis.
It's difficult to predict the progression of the symptoms of ankle arthritis. Some cases progress very slowly and some may progress very rapidly.
Conditions with similar symptoms
There are many small joints near the ankle joint that may mimic ankle arthritis. The closest major joint is the subtalar joint. Because the joints are small and close together and they may be affected by similar activities, it may take specific examination and x-rays to determine which joint is causing the symptoms.
Ankle arthritis may occur as a result of wear and tear, injury or be part of a more widespread arthritis.
Ankle arthritis may cause discomfort and swelling. In addition, it may affect the foot's inability to move up and down as it would to depress the accelerator in an automobile.
Ankle arthritis is diagnosed by a combination of the symptoms, physical examination and x-rays or other imaging tests.
X-rays are commonly employed to diagnose ankle arthritis. Other tests might be used such as MRI or CT scan for unusual conditions. When ankle arthritis is a part of a systemic condition, blood tests may be used for its diagnosis. Occasionally, a bone scan may be useful. Other tests involving injection of solutions into joints may be employed at times.
It's very unlikely that diagnosing ankle arthritis would require any painful procedures or side effects. If some type of injection were to be required, it is usually done by needle stick. While a needle stick may be uncomfortable, it is unlikely to create side effects.
Health care team
A family doctor can often diagnose ankle arthritis. Because there are many structures around the ankle such as tendons and ligaments and many small joints near the ankle, it may be useful to see a specialist. A rheumatologist is a physician with special expertise in arthritis. An orthopedic surgeon is a physician specially trained to diagnose and treat arthritic conditions. Depending upon the type of arthritis and the complexity of the diagnosis, any of these may help you. In addition physical therapists may be of benefit in the early stages of arthritis.
Finding a doctor
To find orthopedic surgeons anywhere in the world, try the American Association of Orthopedic Surgeons "Find a Surgeon" page.
To find rheumatologists anywhere in the world, try the American College of Rheumatology "Geographic Membership Directory" page.
There are many steps in the treatment of arthritis. The first step is weight reduction and activity modification. Weight reduction is helpful because excess weight causes a magnified increase in weight on the small ankle joint. Activity modification is helpful if specific activities cause the symptoms. If these steps are not helpful, over-the-counter analgesic medications such as acetaminophen are used. The next step is bracing and then use of non-steroidal anti-inflammatory medications. When these are no longer successful, surgery may be indicated. Surgical treatment options range from minimally invasive surgery up to and including an ankle replacement or ankle arthrodesis.
Weight reduction and regular low-level exercise that does not stress the joint are the key components of self-management.
Health care team
The health care team for ankle arthritis usually includes a primary care physician, physical therapists, an arthritis specialist and an orthopedic surgeon.
Pain and fatigue
Pain from ankle arthritis is managed with weight reduction, activity modification, analgesic medications, bracing and sometimes surgery. The steps that reduce pain may also reduce the sense of fatigue and accompanies the pain.
The role of diet in treatment of arthritis is controversial. There is no proven dietary pathway that will reduce active arthritis. Nonetheless, a healthy diet that contributes to overall good health will play a positive role in the management of arthritis. In addition, weight reduction is very helpful in the management of ankle arthritis. Because the ankle is a small joint, weight is concentrated in the ankle joint. Small decreases in body weight can have a magnified impact on reduction of symptoms in ankle arthritis.
Exercise and therapy
Exercise and therapy may be helpful particularly in the early stages of ankle arthritis. Rest is common and successful method of reducing symptoms. Unfortunately, resting the ankle requires reduction in walking, standing and running. Swimming and cycling may be well-tolerated.
First-line medication for arthritis of the ankle is similar to that for the hip and knee. Acetaminophen is the first medication employed. A physician may recommend aspirin and NSAIDs, such as naproxen and ibuprofen as well. For more severe types of arthritis, other medications may be employed.
Surgery may be very successful in the treatment of pain and swelling of ankle arthritis. In arthritis that affects only a small part of the joint, surgery may be used to replace a damaged cartilage using cartilage from another part of the body. If arthritis involves the entire ankle, surgery may be helpful to remove painful areas. When arthritis is advanced, ankle replacement with an artificial joint or ankle arthrodesis (fusion) may be used. Arthrodesis is successful and durable but makes the joint permanently fixed. In other words, the joint no longer moves.
Removing fluid from the joint with fine needle aspiration may be helpful in diagnosis and may be slightly helpful in treatment. Injection of medication into the joint may be employed a maximum of two times any given joint. Medication placed into the joint by this method may provide symptom relief for up to a few months.
Splints or braces
Braces and splints are helpful in managing ankle arthritis; the more severe the arthritis, the more rigid the brace. Braces may range from soft lace-up braces to hard plastic boots. The brace or splint will limit the motion of the joint and offload some of its stress.
In the early phases of arthritis, monitoring symptoms is necessary. As the symptoms become more severe, periodic x-ray evaluation may be helpful.
Summary of ankle arthritis
Ankle arthritis is a result of damaged or worn cartilage at the joint that connects the foot to the leg. It may be the result of injury, wear and tear, deformity or inflammation. In the early stages, activity modification, weight loss, rest and acetaminophen are the primary treatment strategies. As the arthritis progresses, bracing and physical therapy may be needed. Surgery can be successful in treating ankle arthritis when it does not respond to non-surgical management.