What Is Ankle Arthritis?
Ankle Arthritis is a condition where the ankle joint cartilage becomes degenerated. The ankle cartilage, which is supposed to be a smooth gliding surface, becomes eroded, coarse and stiff. The ankle joint can become enlarged and full of bone spurs. The ankle joint is responsible for up and down motion of the foot, and is made up of two leg bones (tibia and fibula) and one foot bone (talus). Ankle arthritis can be painful and interferes with everyday life.
What Are The Symptoms Of Ankle Arthritis?
Patients with ankle arthritis have varying degrees of symptoms, which often correlate with the extent of the arthritic degeneration. Typically the symptoms involve pain, swelling and stiffness. Arthritic pain may flare after periods of inactivity (such as getting out of bed in the morning, or after a standing up after a sitting for a while). As the joint loosen up with activity, the pain may decrease as the day progresses. The pain may be deep and intense to superficial and achy.
Movement of an arthritic ankle joint can result in a clicking or grinding sensation, medically known as crepitus. In more advanced cases, the ankle joint develops bone spurs (aka arthritic bone spurs) – which is the body’s mechanism for blocking the painful arthritic motion.
Causes of Ankle Arthritis
Ankle arthritis is most commonly caused by a biomechanical problem or traumatic injuries. Biomechanical imbalance such as flat feet or general lower extremity malalignment may wear out the ankle joint causing premature degeneration. Traumatic injuries such as ankle fractures may damage the joint structure or create malalignment leading to arthritis. predispose. Inflammatory arthritis (such as rheumatoid arthritis) can also affect the ankle joint. Arthritis usually develops gradually over a long period of time, with frequent flare ups until a critical point is reached resulting in ongoing (perhaps daily) pain, swelling and/or discomfort.
When to Seek Treatment
Patients with ankle arthritis seek treatment for some, if not all, of the following reasons: pain, interfering with simple walking, affecting activities, grinding sensation in ankle, enlargement of the ankle, swelling, and/or a change in the structural architecture of the ankle and/or foot.
Depending on your overall health, symptoms and severity of the ankle arthritis, treatment can be conservative and/or with surgery.
Non-operative Treatments For Ankle Arthritis
Non-surgical methods for ankle arthritis are focused at decreasing and/or alleviating symptoms (pain).
Simple Treatments Patients Can Do:
- Wear supportive shoes
- Use an ankle support
- Change your activities
- Lose weight
Non-surgical treatments Dr. Blitz can add:
- Prescribe an oral anti-inflammatory medication. Anti-inflammatory medication is useful to significantly reduce pain and inflammation.
- Prescribe physical therapy. A physical therapist may perform ultrasound and other techniques to decrease inflammation.
- Prescribe custom foot orthotics. A custom foot orthotic is a doctor prescribed arch support that is made directly from a casting (mold) of your feet, and theoretically should provide superior support compared to shoe insert that you would purchase from a pharmacy. In the case of ankle arthritis with a flat foot, the orthotic may be able to improve the position and alleviate discomfort.
- Prescribe custom ankle brace. A custom ankle brace is made from a mold of the ankle to limit painful motion of the ankle.
- Prescribe custom ankle foot orthotic. A combined custom foot and ankle brace can support the foot and limit painful motion of the ankle.
- Give cortisone injection. An intra-articular cortisone injection is a powerful anti-inflammatory medication that is used to rapidly reduce the pain associated with an arthritic joint. The pain relief that may be experienced from the injection(s) is often temporary.
- Give PRP injection. Platelet-rich plasma (PRP) is a concentration of growth factors derived from a person’s own blood, and can be injected directly into the arthritic joint. The PRP is thought to stimulate stem cells to decrease inflammation and symptoms.
- Give viscosupplementation injection. The natural lubrication of the joint can be artificially supplemented with a gel-like substance called hyaluronan (derived from chicken combs) to provide cushion, shock absorption and pain relief. This treatment is only FDA approved for knees, and treatment for the ankle is off-label use.
Ankle Arthritis Surgery
Surgery for arthritis of the ankle varies depending on the location of arthritis, severity of arthritis, malalignment, and the presence of structural foot deformity (i.e., flat feet). But, in general, the procedures are separated in two kinds: Joint sparring (preserves the joints) or Joint destructive that eliminates the ankle joint through fusion or replacement.
- Joint Sparing Procedure. These procedures involve “surgical cleaning” the arthritic components of the joint(s) to alleviate pain and increase motion. These include: Arthroscopic Debridement, Exostectomy, Arthrodiastasis. These procedures are generally better indicated for mild or moderate arthritis. The benefit of the joint sparing procedures is that they do not “burn and bridges” and if they don’t resolve ones symptoms to a satisfactory level, then more advanced procedures can be implemented.
Arthroscopic Debridement: Ankle arthroscopy is a procedure where the joint can be accessed via small cameras, and the joint can be “cleaned up” of arthritic debris. Scar tissue can be excised, bone spurs removed and bone cysts evacuated. This technique is best for mild to moderate ankle arthritis, and its effectiveness depends on the extent of the arthritis. The recovery after ankle arthroscopy is fairly quick, and patients are frequently ambulating right after the procedure, depending on the extent of the debridement.
Exostectomy: Arthritic bone spurs can be removed through a procedure called Exostectomy. In the ankle joint, the arthritic bone spurs may form on the front of the ankle joint and become large motion blocking spurs. While the bone spurs limit motion, they rub and bang against each other which can result in pain. In some cases removal of these bone spurs can reduce pain and increase range of motion, however, removing the bone spurs does nothing to manage the underlying arthritis. Exostectomy allows for the arthritic joint to continue to move but is generally for mild arthritis. The recovery after exostectomy is also rapid as patients tend to be ambulating immediately after the procedure with little down time.
Arthrodiastasis: This procedure involves invasive distraction to the ankle joint to offload the joint to promote cartilage healing. An external fixator (a metal circular device that bolts into the leg and foot bones) is used to provide the distraction which is worn for several weeks. This technique is used for varying degrees of ankle arthritis. This is the most aggressive of the joint sparing procedures, and because the surgery involves an external fixator patients are often immobile for 6-8 weeks.
- Joint Destructive Procedures. Destructive procedures involves locking the joints in place by a fusion (or bone mending procedure). Joint replacement are also considered joint destructive procedures. The extent of the arthritis determines whether or not the ankle joint could be “saved” and joint destructive procedures are End stage arthritis is when there is significant loss of the joint cartilage, bone cysts, arthritic bone spurs and/or bone cysts.
Ankle Fusion (Ankle Arthrodesis): Ankle fusion is the gold standard time tested procedure for end stage ankle arthritis. An ankle fusion is a procedure where the arthritic ankle joint is removed and the bones are mended (fused) together. An ankle fusion allows for structural abnormalities of the ankle to be corrected at the fusion site. There are several surgical techniques for ankle fusion, but generally the procedure requires inserting screws across the ankle joint to lock the position of the ankle. While the fusion eliminates motion is also eliminates pain. Most people who require ankle fusion have already experienced many years ankle stiffness with limited motion and have already compensated their gait and walking patterns so that locking the ankle in place with fusion does not typically adversely affect their walking, but has the added benefit of eliminating pain. The recovery for ankle fusion is typically 6-8 weeks in a cast/boot with crutches until the bone mends. An ankle fusion is a life-long solution for ankle arthritis.
Ankle Replacement: Ankle replacement (also called ankle arthroplasty) is an artificial metallic and/or polymer replacement of the ankle joint. The procedure allows for continued motion of the ankle, though limited. The ankle replacement technology has advanced considerably in the past decade and the implants have become smaller and more customized. Like any joint replacement, the implant has a limited lifespan and may require revision or replacement in the course of ones life. The recovery for ankle fusion is typically 6-8 weeks in a cast/boot with crutches until the bone mends, followed by rehab.
Ankle Arthritis Surgery Recovery
Recovery depends on which surgery is performed. Arthroscopy and arthritic bone spur removal is much less invasive, and patients can usually ambulate after surgery. Ankle fusion and replacement protocols typically involve non-weightbearing with cast and crutches until the bone mends – a process that can take 6 weeks to 12 weeks.
What Anesthesia Is Needed For Ankle Arthritis Surgery
Depending on the surgery, it can be performed as an outpatient or an inpatient. Major ankle fusions and replacements may require a hospital stay. Most ankle procedures are performed under regional, spinal or general. Local anesthesia is less effective for these surgeries.
What Are The Risks Of Ankle Arthritis Surgery
There are general risks associated with foot and ankle surgery (or any surgery) and the use of anesthesia. Complications may occur and are not necessarily your fault, or the fault of your surgeon. Nonetheless, you should understand the risks.
Ankle Surgery complications include, but are not limited to: infection, pain (temporary or permanent), swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), malunion, nerve injury, neuroma, pain syndrome, RSD, disability, recurrence, hardware problems, metatarsalgia, unsightly scar, stiffness, weakness, hardware problems, need for revisional surgery, and/or catastrophic loss.