Ankle Arthritis

Ankle arthritis can cause significant disability and affect daily living

Arthritis in the ankle can lead to pain, swelling, deformity, and instability in the ankle joint. Ankle arthritis affects the tibiotalar joint, which forms between the shin bone (tibia) and ankle bone (talus).

The incidence of ankle arthritis is five to 10 times less than arthritis of larger joints like the hip and knee.

Types of Ankle Arthritis

common types of Ankle arthritis

Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease where the cartilage that cushions the ends of a joint wears away gradually. Osteoarthritis often occurs because of typical wear and tear on a joint that happens with age. But many cases of ankle osteoarthritis are related to a previous ankle injury. Injury can damage the cartilage directly or change how the ankle joint works, leading to cartilage deterioration over time.

Post-traumatic arthritis

This type of arthritis develops in the foot as a result of injury, even one that happened a long time ago. For example, a sprain, fracture, or dislocation in the ankle may damage cartilage. That can lead to premature deteriorating of the joint. Symptoms may appear within a few years, or it can take decades for joint damage from an injury to cause pain.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease, in which the body’s immune system attacks itself. The joints of the ankles can be affected by RA. Difficulty with ramps, inclines, and stairs are the early sign of rheumatoid arthritis. Standing and basic walking can become painful as the RA in the ankle advances.

Other types of inflammatory arthritis such as psoriatic arthritis and peripheral spondyloarthritis can also affect the ankle joint.

Diagnosis

Blood tests- CBC,ESR,CRP,RA,URIC ACID, ACCP

X-ray-Both leg standing view to see the arthritic changes and alignment also

CT Scan- CT scan is useful tool to see the quantity of arthritic changes of ankle joint.

MRI- MRI is useful to see the soft tissue involvement and for bone marrow changes.

 

Management

The goal with these treatments is to help patients function and do their daily activities with less pain.

Medication for Arthritis in the Ankle

Medications are an important part of treatment for arthritis in the ankle. They can help slow bone loss, relieve inflammation, and ease pain. Here are the types of medications used commonly in arthritis treatment.

Nonsteroidal anti-inflammatory drugs

NSAIDs  can help relieve pain and swelling in the joints.

Steroid injections: In certain cases steroid injection into the ankle joint can help relieve inflammation. These shots shouldn’t be done repeatedly, though Frequent injections damage cartilage

Analgesics: Analgesics such as acetaminophen help with pain relief. That makes them good for people who can’t take NSAIDs if they’re allergic to them or have stomach issues. .

DMARDs: Disease-modifying anti-rheumatic drugs include conventional immune-modifying drugs, such as methotrexate, as well as biologics, which are more targeted to certain immune system chemicals and pathways  work slowly to change the course of inflammatory disease. They’re only used to treat inflammatory arthritis such as psoriatic arthritis and rheumatoid arthritis.

Lifestyle Modification

Lifestyle modifications are a big part of helping treat arthritis in the ankle.

Hot and Ice Fomentation: Stiff and sore ankles can be relaxed and soothed with hot fomentation. Ice can help numb areas affected by joint pain and reduce inflammation. Ice fomentation is helpful for acute exacerbation of arthritis symptoms (swelling and redness), and heat is good for chronic pain symptoms.

Ankle exercise: It’s important to control your weight with regular, low-impact aerobic exercise. Do gentle exercises that don’t stress the ankle joint, such as swimming or cycling. Walking is one of the best exercises if done correctly with good shoes.

Limit high-impact activities, such as running or tennis. Also stay away from soccer and kickboxing.

Shoes wearing: Cushioned shoe inserts can help create less pain in the ankle joint. A major cause of ankle arthritis is trauma. Reducing the amount of high-impact activity and providing cushion to the ankle joint helps prevent joint damage,

A rocker bottom added to the sole of your shoe can help decrease impact on your heel while standing or walking,

Supportive ankle brace: A brace called ankle-foot orthosis can help hold the ankle joint in position. It will support the joint, take pressure off the ankle, and prevent extra motion. It spans both the ankle and foot and looks like an ankle brace with a foot orthotic attached.

Custom-made orthotics are the best choice for ankle arthritis,

Use an assistive device: A cane or walker can help reduce stress on the affected joint and help improve mobility and stability.

Surgery

You may need surgery for your ankle arthritis if your pain causes disability and isn’t relieved with nonsurgical treatment.

If there is significant spurring of the ankle joint, the spurs can be resected via ankle arthroscopy first before fusion is attempted to try and restore ankle motion. However, all non-surgical measures should be attempted before surgery is planned.

Ankle arthroscopic repair: 

Ankle arthroscopy is useful to clean up loose joint bodies, or small pieces of bone spurs in the joint that have broken off over time

Ankle arthroscopic repair is helpful in the early stages of arthritis in the ankle and for those with limited ankle arthritis.

Ankle fusion surgery: This surgery, also called arthrodesis, is used in end-stage ankle arthritis. The procedure decreases movement of the worn-out portion of the joint/cartilage, which in turn decreases pain. The joint is then held in place with a rod or plates and screws

The surgery is ideal for those with excessive bone loss, poor ligaments, poor bone quality, or previous infection. It’s the most common surgical treatment for end-stage ankle arthritis.

Total ankle replacement: In this procedure, damaged cartilage and bone are removed and replaced with new metal or plastic joint surfaces to restore the joint’s function. This procedure helps preserve joint motion.

Ideal candidates have good bone quality and normal tendons and ligaments. Patients with pre-existing arthritis in smaller joints in foot or hip or knee impairment that would be worsened by loss of ankle joint motion might be better candidates for ankle replacement