Ankle Arthritis.
Edited By: Bruce J. Sangeorzan, M.D.
Last updated Wednesday, February 08, 2006
AboutBasics 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.
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Click here to view Dr. Bruce, UW professor and chief of Harboview Orthopedic Service and
Traumatology, and Dr. Sigvard, UW professor and director of Sig T. Hansen
Foot and Ankle Institute, discuss surgical options and the outcomes of treatment for ankle arthritis. |
Prognosis 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 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.Curability 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.Energy 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.
Diet here 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.Incidence 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.
Communicability 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.Anatomy 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.
Initial symptoms Pain and swelling are the key warning signs of ankle arthritis.Progression 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.Causes Ankle arthritis may occur as a result of wear and tear, injury, or be part of a more widespread arthritis.Effects 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.Diagnosis Ankle arthritis is diagnosed by a combination of the symptoms, physical examination and x-rays or other imaging tests.Diagnostic 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.Effects 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 orthopaedic surgeons anywhere in the world, try the American Association of Orthopaedic Surgeons "Find a Surgeon" page.
To find rheumatologists anywhere in the world, try the American College of Rheumatology "Geographic Membership Directory" page.
Treatment 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.Self-management 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.Diet 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.
Medications 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 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.Joint aspiration 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.Long-term management 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.Surgery for Ankle Arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-731-4830 to make an appointment.
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