ANKLE

Arthritis

What Is Ankle Arthritis?

Most ankle arthritis is "wear and tear" (or osteo-arthritis) arthritis. Other forms of arthritis exist which can affect the ankle such as inflammatory arthritis, an example of which would be rheumatoid arthritis.

What Symptoms Might I Have?

It is possible that in the early stages or even in the "late" stages of ankle arthritis that one may experience little in the way of symptoms.

Most commonly pain is the presenting symptom and in ankle arthritis this is usually well localised to the level of the ankle joint. It can be felt anywhere circumferentially around the ankle joint but usually it is felt deep within the joint. The intensity and duration of pain from an arthritic ankle varies significantly person to person and at different times. Generally, early symptoms in ankle arthritis are pain and perhaps swelling, after prolonged weight bearing or high impact type activities. If the ankle arthritis progresses then pain can become a more frequent occurrence and provoked by progressively less and less activity. Eventually pain can become present most of the time, even when non-weight bearing or at night in bed.

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, treatment is based 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.

If I Have Been Diagnosed with Ankle Arthritis How Can I Help My Symptoms?

Methods of relieving symptoms are the same as those used for the relief of arthritic symptoms in any lower limb joints. In other words ensure one is not carrying excess weight, reduce heavy impact activities on the joint, and 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.

Surgery

Ankle Arthroscopy
This is designed to minimise the pain, swelling and stiffness in the arthritic ankle joint. Through two or three small holes, instruments are inserted into the ankle joint to wash debris from it and to remove loose pieces of bone, cartilage, inflamed tissue and bone spurs (lump or outgrowth of the bone, formed when the body tries to repair itself by producing more bone – usually in response to rubbing, pressure or stress over a period of time). You will need to rest and ice your ankle for 48 hours after surgery, and have a short post operative physiotherapy programme. You will normally see 80% good or excellent results.

Ankle Fusion
If simple arthroscopy does not relieve the symptoms, then a more permanent solutions such as an arthroscopically assisted fusion may be required. Ankle fusion involves preparing both sides of the arthritic joint(left) back to healthy and bleeding bone (right). 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).

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%.