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Ankle Arthritis


Updated May 23, 2014

The ankle joint is affected by arthritis much less often than other joints. When patients have ankle arthritis, they have worn out the joint between the shin bone (tibia) and ankle bone (talus), also called the tibiotalar joint.

Causes of Ankle Arthritis

Common factors that lead to ankle arthritis include:
  • Previous ankle injury
    Ankle arthritis is most commonly the result of a prior injury to the ankle joint. In patients who sustain an injury such as an ankle fracture, the cartilage may be damaged and lead to accelerated arthritis.

    When the ankle is injured, it is also susceptible to an injury called osteonecrosis. When osteonecrosis occurs as the result of an ankle injury, a portion of the bone has damage to its blood flow. Osteonecrosis can also lead to ankle arthritis.

  • Rheumatoid arthritis
    Patients with rheumatoid disease can have ankle arthritis. Rheumatoid disease causes joint inflammation and damage to the cartilage. Over time, this can lead to significant problems, necessitating treatment.

  • Infection
    Infections of a joint can lead to damage of the cartilage cells. Because cartilage cells cannot regrow, the damage from an infection can last permanently.

  • Genetics
    The effect of genetics on the development of arthritis is not well understood, but we do know that some people have a genetic tendency to wear out joints faster than others.

  • Body weight
    Patients who are overweight place a larger burden on their hips, knees, ankles, and feet. These patients have more of a tendency to develop arthritis, and often have more accelerated damage to the joint cartilage.

Symptoms of Ankle Arthritis

Ankle arthritis most commonly causes pain around the joint, and the most frequent reason for patients to seek treatment is the pain associated with this condition. Other common symptoms of ankle arthritis include:
    • Stiffness of the ankle
    • Swelling around the joint
    • Bone spurs causing a lumpy appearing joint
    • Deformity of the joint
    • Instability, or a feeling the joint may "give out"
Less commonly, ankle arthritis can lead to irritation of the nerves around the joint causing tingling and numbness in the feet and toes.

Ankle arthritis can usually be easily diagnosed with an examination and an x-ray. Once patients are diagnosed, nonoperative treatments should be attempted. Most patients can find relief through steps including activity modification and changes in their footwear.

Ankle Arthritis Treatments

Treatment of ankle arthritis should always begin with simple steps including:
  • Footwear Changes
    One of the simplest steps to take is to try some shoe modifications. Cushioned inserts can help alleviate symptoms. Another helpful step is to have a shoe repair specialist add a 'rocker-bottom' to the sole of the shoe.

  • Activity Modifications
    Activity modification is an important part of treatment, and patients unwilling to change their lifestyle generally should not consider surgical treatments for ankle arthritis. Patients should try to limit impact activities including running and jumping.

  • Braces
    A brace can be fabricated to help hold the ankle joint in position. These braces, called ankle-foot-orthoses or AFOs, will support the joint and prevent excessive motion.

  • Anti-Inflammatory Medications
    Anti-inflammatory medications can be helpful in patients with moderate symptoms of ankle arthritis. Patients should use anti-inflammatory medications carefully as there are possible side effects, especially with longer-term use of these medications.

  • Cortisone Injections
    Cortisone injections can be extremely helpful in the management of ankle arthritis, especially in an acute flare up of pain. While cortisone injections cannot be performed regularly, the occasional cortisone shot is helpful in most patients with ankle arthritis.
If these treatments can't alleviate ankle arthritis pain, then more invasive treatments may be considered. Surgical options include:
  • Ankle Arthroscopy
    Arthroscopic surgery can be useful in patients with limited ankle arthritis, but it is usually ineffective for more extensive ankle arthritis. Ankle arthroscopy is most helpful when small bone spurs have developed around the joint causing "impingement," or the bone spur becoming pinched when the ankle moves up and down. During arthroscopic surgery, the bone spur can be shaved to promote motion of the joint.

    Unfortunately, if the ankle arthritis is more extensive, arthroscopic surgery will likely be unhelpful. When a significant amount of the cartilage has worn away, the joint will not benefit from an arthroscopic procedure.

  • Ankle Fusion Surgery
    Ankle fusion surgery is the standard treatment for advanced ankle arthritis. This surgery removes the worn out portion of the joint, and then permanently holds the bones in a solid position.

  • Ankle Replacement Surgery
    Replacement surgery is a more controversial treatment for ankle arthritis. The success of fusion surgery is under debate, and there is not too much experience with replacement surgery for ankle arthritis. As more of these procedures are being performed, the implant design is being improved. This will likely lead to better results.
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