The ankle joint is the natural hinge that connects the bones of the leg to the bones of the foot. The joint surfaces are covered by cartilage, which is a very slippery tissue that allows efficient motion.
Ankle arthritis represents thinning and degeneration of the cartilage inside the joint. There are several different causes of ankle arthritis, including fractures, multiple sprains, infection, and even wear and tear. These causes are grouped into “osteoarthritis”. Other causes of arthritis result from joint inflammation due to a systemic disease, such as rheumatoid arthritis, gout, and even hemophilia.
If you have ankle arthritis, you will often note pain that occurs and worsens with physical activity. There may also be “start-up pain” that occurs when you first stand up after sitting for a long period of time.
The initial treatment of ankle arthritis is usually non-operative. Anti-inflammatory medications may be used for mild disease. However, the long term use of anti-inflammatory medications can cause problems with the kidneys and gastrointestinal system. Low profile braces often help by decreasing painful motion. Steroid injections may also be helpful, reducing the painful inflammation inside the joint.
For pain that does not respond to non-operative measures and significantly interferes with activities of normal living, surgery may be necessary. There are several surgical options.
In cases in which the arthritis is limited to the front of the joint with painful spurs that pinch against one another, a simple “cheilectomy” may help. This involves removing the painful spurs and is often most helpful for patients with pain when walking up hills or stairs.
If there is malalignment that causes localized arthritis affecting only one side of the joint, an “osteotomy” may help. This involves realigning the tibia and fibula bones of the leg such that your body weight is redistributed to the healthy side of the joint.
With more advanced disease involving the entire joint, a fusion may be recommended. With a fusion, the joint surfaces are roughened and then held together with plates or screws. The body is “tricked” into thinking that a fracture has occurred. Over the next 6-12 weeks, the body heals the presumed fracture and the two bones become one. Once the fusion is complete the arthritic joint is no longer present and pain is relieved.
Finally, in select cases, ankle replacement may be possible. Ankle replacement is an evolving technology in which a metallic joint is implanted. Ankle replacement surgery is usually reserved for patients with advanced arthritis who meet specific criteria for age, activity level, and weight.
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