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Ankle Arthritis by Dr. Bryan W. Lapinski

The ankle is a joint that consists of the adjoining cartilage of three bones: the tibia, fibula, and talus. The incidence of ankle arthritis has increased over the last several decades. While arthritis of the hip and knee is most commonly idiopathic, or from general wear and tear, ankle arthritis from this cause is very rare. Post-traumatic arthritis is by far the most common cause, encompassing up to 80% of cases. This can be from prior trauma to any bone that makes up the ankle joint. Systemic inflammatory disorders, such as rheumatoid arthritis, can lead to degradation of the ankle cartilage and subsequent arthritis. Other causes include limb deformity, recurrent ankle sprains, adult-acquired flatfoot deformity and neurologic conditions.

The most common symptoms of ankle arthritis include pain and swelling. Stiffness often occurs, and patients often walk with the leg turned outward in order to decrease the pain they are experiencing. The pain can be in the front of the ankle, or along the inner and outer portion of the ankle. While arthritis and pain can progress over decades, in some cases it can progress rapidly. Ankle arthritis can cause a decrease in the quality of life and has been shown to cause as much disability as hip and knee arthritis.

Non-operative Management

The first step in the treatment is weight loss and activity modifications. The ankle joint sees a tremendous amount of force, up to 5-7 times of body weight, so even a small reduction in weight can have a large effect on decreasing symptoms. Exercises such as swimming and biking are better tolerated than running. If these fail to provide relief, anti-inflammatory medications can be prescribed. An occasional steroid injection can be beneficial. In addition, certain braces can be prescribed to decrease the motion and forces across the ankle joint.

Operative Management

If non-operative management does not alleviate the pain, surgery may be helpful. The type of surgery depends on many factors, such as the severity and cause of the arthritis, the age and activity level of the patient, as well as concurrent medical problems.

If only a small portion of the joint is involved, cartilage can be taken from another part of the body or from donated cartilage to replace the damaged cartilage. If bone spurs are the cause of pain in the ankle, they can be removed to provide relief.

In patients with more severe arthritis, ankle fusion or ankle replacement can be performed. Ankle fusion has the advantage of being more durable and is more commonly performed in younger individuals or patients that place a higher demand on their ankle, such as a heavy laborer. The disadvantage is that over a period of 10-20 years, the adjacent joints in the foot become arthritic, and further surgical intervention may become necessary.

Ankle replacement has the advantage of preserving motion of the ankle joint, which has a beneficial effect on walking and exercising. In addition, because the ankle joint continues to move, there is less chance of experiencing arthritis in adjacent joints in the foot in the future.

The future of the treatment of ankle arthritis is at an exciting time. Techniques continue to evolve, and further research in cartilage replacement and new components in total ankle arthroplasty hold promise in the treatment of ankle arthritis.

Bryan Lapinski, Foot and Ankle specialist
Gallatin, Hendersonville, Skyline