Arthritis is a common ailment that millions suffer from in the United States and around the world. The most common form is osteoarthritis which is caused by the wear and tear of joints over the course of years. This is also known as degenerative joint disease. It is most common in the fingers, wrists, hips, knees, ankles and toes. The signs and symptoms are pain and stiffness in the morning that eases with motion within an hour’s time, aching or throbbing with activity and/or throbbing at night with joint swelling, heat and redness. Although nearly all seniors will have arthritis in some of these locations, it is not limited to the older population. Improper alignment of joints can significantly accelerate this process and lead to substantial arthritis early in life.
Other forms of arthritis include rheumatoid arthritis, post traumatic arthritis and reactive arthritis. Rheumatoid arthritis is caused by a genetic condition that attacks most of the joints of the body and causes an accelerated and severe degeneration of the joint. It causes weakening of the cartilage (which allows for smooth motion of the joints), leading to quickly deteriorating joints. Post traumatic arthritis results after a fracture or other severe injury. The damage to the cartilage, as a direct result of the injury as well as the poor alignment of the joint that can result, cause a speedy breakdown in the joint, causing pain and inflammation. Reactive arthritis is an uncommon disorder that is as a result of other conditions, such as irritable bowel syndrome or certain types of bacterial infections. Its results are sometimes reversible but in the case of irritable bowel syndrome, it can lead to a quicker breakdown of the cartilage.
Ankle arthritis is a very common disorder. The anatomy of the ankle is unlike any other joint of the body. It is a complex relationship between the talus (the ankle bone) and the tibia and fibula (the two lower leg bones). All three bones interact with one another to allow both the common hinge motion most commonly associated with the joint as well as a subtle side to side motion that allows for a more efficient walking pattern and adaptation for unstable walking surfaces. Unlike other joints, such as the knee or hip which have large muscles crossing them for greater stability as well as very large and strong ligaments, the ankle joint has no muscles that cross it. The ankle also has a few ligaments that are not as strong as other joints. Because of the design of the ankle, it is more prone to injury and is the most commonly sprained joint in the body. More frequent injury makes the ankle very prone to earlier and more severe arthritis.
Ankle arthritis is diagnosed by clinical exam and x-rays. Clinically there will be pain and swelling of the joint with a decrease in the amount of motion and in severe cases grinding or popping when the joint is moved. On x-ray there will be a smaller joint space, formation of bone spurs and changes in the density of the joint.
There are essentially 3 levels of ankle arthritis, classified as mild, moderate and severe, and each has a different strategy for treatment. For mild arthritis, usually anti-inflammatory medications by mouth and/or with topical creams help to effectively manage the pain and swelling. Decreasing high impact activities along with proper shoes and in some cases shoe inserts will help to decrease the risk of the arthritis getting worse.
Moderate arthritis is also treated with anti-inflammatory medications. Ankle braces and in some cases an injection of steroid into the joint can help significantly. There are also surgical options with this level of arthritis and an ankle arthroscopy, where a camera is inserted into the joint with a small incision, can be used to help decrease the inflammation and help repair damaged cartilage. Small spurs that have formed can also be removed with this method. The recovery time or an ankle arthroscopy is very short, with limited time away from work, making it a very good option for a large majority of patients.
Severe arthritis, or end stage arthritis, has more limited options. The main goal is to decrease pain and maintain function of the foot and mobility of the patient. Prefabricated or custom ankle bracing can work for many people with end stage arthritis. However, in many cases, some sort of surgical intervention will eventually be needed to allow better function and allow activity with less pain. Full surgical intervention at this stage is in the form of ankle joint replacement or ankle joint fusion. Unlike knee or hip joint replacement, ankle joint replacement has limited usefulness currently. Due to the relatively small size of the ankle joint, in addition to the poor stability of the ligaments and tendons as discussed above, ankle joint replacements do not have the longevity that a knee or a hip replacement does. By comparison knee and hip joint replacements can last for more than 15 years on average, where ankle joint replacements last about 7 years on average. An ankle joint fusion, though it sounds extreme, is a very good option for patients with end stage arthritis. Though the ankle joint has no motion after a fusion, the surround joins pick up some of the slack and most people have normal or near-normal walking, allowing them to resume the activities of daily life. Ankle joint fusion is a last resort option and is usually indicated in those patients older than 60.
No matter what the cause or what stage of arthritis you are experiencing, the doctors at Advanced Foot and Ankle Center are very experienced in treating these conditions, using the most up to date techniques to decrease pain and improve the quality of your life.
Advanced Foot and Ankle Center
Eric Silvers, DPM
Dustin Lloyd, DPM
Christopher WItt, DPM