Non-Weight Bearing Medical Conditions

Ankle Arthritis

• Content Source: The Foot and Ankle Clinic Read full article here

• What is ankle arthritis?

  Most ankle arthritis is as a result of what is known as "wear and tear" (or osteoarthritis). Other forms of ankle arthritis exist which can affect the ankle such as inflammatory arthritis, an example of which would be rheumatoid arthritis
• The inside of a normal ankle joint is lined completely by smooth cartilage which looks very like the covering of the joint one sees with a chicken drum stick for example. The arthritic ankle loses this smooth cartilage lining which normally allows for low friction and pain free weight bearing.
• Once lost, the underlying bone is exposed in ankle arthritis. This is not a comfortable surface for weight bearing and pain is generated from inside the joint. As well as losing the smooth cartilage lining in ankle arthritis there are other secondary changes which occur in the joint such as the development of painful, red, inflamed soft tissue known as synovits which also can produce pain in ankle arthritis. As the cartilage is being "worn away" in ankle arthritis loose flaps of cartilage can become partially detached from the arthritic joint and these can also produce pain and also sometimes a sensation of locking from the arthritic ankle joint.

• The natural history of ankle arthritis

  There is a great deal of individual variability in the level of symptoms from ankle arthritis and also the rate at which it progresses. Generally, one should base one's treatment upon the level of symptoms that the ankle arthritis is currently giving as opposed to any extrapolation of how severe the symptoms from ankle arthritis might be in the future.

• What causes ankle arthritis?

  Ankle arthritis is commonly the result of either a direct injury into the joint such as an ankle fracture or the result of a longstanding and symptomatic ankle instability. Occasionally it may occur secondary to chronic and recurrent inflammation such as with rheumatoid arthritis, gout or the recurrent bleeding of haemophilia.

• If I have been diagnosed with ankle arthritis how can I help my symptoms?

  The general things which one can do which are helpful for arthritis in all limb joints is to ensure one is not carrying excess weight, reduce heavy impact activities on the joint, use occasional non-steroidal anti-inflammatory tablets as required. A lightweight and stiff soled walking boot can also be useful in relieving symptoms of ankle arthritis. The sole itself should be too stiff to flex and run with a gentle curve from heel through to the toe, a rocker type sole.

• Surgical management of ankle arthritis

• Arthroscopic Debridement

• A debridement for ankle arthritis is useful in the earlier stages of the arthritic process. It is normally performed as a day case procedure and generally patients can weight bear straight away on the operated ankle. The success rate for the procedure is in the region of 75%-80%. This corresponds to the percentage chance of improvement but not complete symptom resolution. On occasion it can take a number of months before this benefit is achieved. It needs to be borne in mind that there is approximately a 5% chance of significant symptomatic worsening following debriding an arthritic ankle.

• Ankle Fusion

  Ankle fusion involves preparing both sides of the joint back to healthy and bleeding bone. The arthritic joint lining is removed and the ankle joint is placed in a functional position and held there until the bone has grown across the joint and the ankle is thus fused. The ankle is held in position whilst the fusion is occurring and this is most commonly done with large screws which are buried beneath the skin. Occasionally a large metal rod may need to be inserted through the heel to compress the ankle and sub-talar joints (known as a double fusion). In cases where infection is present a device known as an Ilizarov frame may be used to compress the ankle joint and hold it in position until fusion has occurred. On average it takes three months for bone to be fairly soundly fused but on occasion it can take significantly longer.

• Ankle Replacement

  Ankle replacement involves replacing the two worn out surfaces with replacement highly polished surfaces and adding a high molecular weight polyethylene spacer between the two surfaces. Ankle replacement generally maintains the range of movement which a patient has pre-operatively. It is not suitable for heavy manual or sporting activities and probably has a ten year survivorship in the region of 85%. The commonest surgical treatments for the severely arthritic ankle are either a fusion or a joint replacement. In less advanced or less symptomatic cases other surgical managements may work.
• There is no precise definition of severe arthritis and a persons appreciation of pain, the commonest complaint in arthritis, is very subjective. However a clear example of severely arthritic symptoms would be ankle pain, continually present, restricted walking to 15 minutes only, responds little to painkillers and little changed or worsening over a number of months.