Ankle arthritis occurs when there is a loss of cartilage from the ankle joint. Cartilage is the smooth white tissue that covers and cushions the end of the bone on either side of a joint. It allows for pain-free motion at the ankle with minimal friction.
The ankle joint consists of the ends of the tibia and fibula bones which together form a perfectly conforming “roof” on top of the talus.
Ankle arthritis can develop for many different reasons:
• Post-traumatic – from prior fractures or severe sprains
• Recurrent instability
• Osteoarthritis – “wear-and-tear” arthritis
• Rheumatoid arthritis
• Cartilage damage
• Misalignment of bones above the ankle
• Avascular necrosis (dead bone)
• Instability or giving out
• Grinding or clicking of the ankle
The foot and ankle doctor will first examine the ankle to identify where the pain occurs, the range of motion and stability of the ankle, and the overall alignment of the leg.
Standing X-rays will be ordered to evaluate the remaining cartilage space left in the ankle joint between the ends of the bone. X-rays can also reveal other problems that may affect treatment, such as mal-alignment issues in the bone and joints around the ankle or possibly bone that is dead or collapsed.
Special tests may also be necessary to determine the best treatment for ankle arthritis, including CT scans or MRI.
Non-surgical Treatment for Ankle Arthritis
As with most forms of arthritis in the body, non-surgical options are usually attempted first for most patients.
• Anti-inflammatory medications may alleviate pain and help with swelling.
• Comfortable shoewear with a cushioned, rockerbottom sole can help with walking and dissipate stress from the stiff ankle joint.
• Wearing a brace can be very effective for patients with ankle arthritis. The brace can limit painful grinding of the ankle and also provide a sense of improved stability.
• Steroid injections of the arthritic ankle joint can also temporarily relieve pain, similar to knee arthritis.
Unfortunately, most arthritis in the body tends to progress with time, leading to more pain, stiffness, and difficulty with daily life; the ankle joint is no different. Eventually, non-surgical methods may no longer work and the patient may seek out surgical options for a more definitive solution.
Some patients have only minor damage to the cartilage in the ankle joint. In these cases, it may be possible to perform a minimally invasive procedure called ankle arthroscopy to clean out and repair the damaged areas. Loose pieces, bone spurs, scar tissue and inflammation can be removed to relieve pain.
The surgeons at The Institute for Foot and Ankle Reconstruction at Mercy have extensive experience with the most advanced cartilage repair techniques available. These include bone marrow stimulation, cartilage transplant and cartilage grafting.
If the damage to the cartilage is extensive, an ankle fusion may be a good option to relieve pain and improve overall function.
Ankle fusion surgery involves removing the remaining cartilage from the joint and roughening up the ends of the bone to make them bleed. By using screws or plates to hold the joint together, the body will heal or fuse the bones into one solid structure. This results in a stiff ankle, but the relief of pain is usually well worth the loss of motion for most patients.
Indeed, ankle fusion has been a dependable surgery for many years and remains the most common technique to address severe ankle arthritis.
In patients with end-stage ankle arthritis, another treatment option is an artificial total ankle replacement. Similar to hip and knee replacement, the arthritic ends of the bone on either side of the ankle joint are removed and resurfaced with metal. Between the metal pieces is a specially engineered piece of plastic that allows for smooth gliding of the joint.
This is an attractive option because patients can experience similar pain relief to an ankle fusion, but retain more natural motion of the joint. This results in a more normal walking pattern. However, ankle replacements tend to wear out over time and another surgery may be necessary. Also, not all patients are good candidates for ankle replacement.
A foot and ankle surgeon will be able to thoroughly evaluate your ankle arthritis and discuss with you the advantages and disadvantages of ankle replacement versus fusion.