Ankle Arthritis
What is it?
Arthritis, meaning inflammation of a joint, can
occur at any joint in the human body. Because the
ankle is a commonly injured joint in the body,
patients may experience problems much later in
life due to the wear and tear (“degeneration”)
that slowly occurs over a period of years after an
injury. Degenerative arthritis means inflammation
of a joint due to wear and tear. This condition is
called osteoarthritis. Doctors may also use the
term “arthrosis” to describe the condition of
a worn-out joint. There are many causes for
arthritis, and the term is used to describe
inflammatory conditions, such as gout, infection,
and rheumatoid arthritis.
Who gets it?
In recent years, there has been increasing
evidence that osteoarthritis is genetic and has a
tendency to occur in families. Research suggests
that osteoarthritis that occurs without any injury
may be related to the chemical make-up of the
cartilage in the joint.
What are the symptoms?
When the joint sustains an injury, the
cartilage holding the joint together becomes
damaged. The patient does not typically know that
damage has been done, and they may not be
experiencing significant pain. When asked if the
pain limits their activities, the first answer may
be “no”. However, in careful questioning, one
would ask a patient “what activities are they
doing now that they were doing five years ago that
they cannot do now because of discomfort in their
ankle”. The patient may be surprised by their
response.
In the severely damaged ankle joint, the
cartilage tends to rip from the bone. The
fragments of cartilage will then float around in
the joint causing pain and additional damage.
Because cartilage does not heal or grow back, this
causes a defect in the joint. Over time, these
defects fill with scar tissue, causing more pain
and instability to the joint. The joint ultimately
reaches a point when it is no longer able to
properly function without significant pain because
of the continual damage, resulting in increased
inflammation and severe pain.
Diagnosis
Your orthopaedic physician will obtain a family
history, considering all factors important in
determining the type of arthritis you may have. He
will also conduct a thorough physical examination
of the ankle joint to evaluate and determine the
type and extent of damage to the joint. In this
physical examination, the physician will measure
the range of motion of the ankle, and may draw
fluid from the joint to determine if an infection
is present. X-rays will then be taken to assess
the amount of damage to the joint and determine
the proper diagnosis.
Non-Operative Treatment
Arthritis in its mildest form may not need any
treatment whatsoever except simple activity
modification – avoiding impact activities such
as jumping – and recommending activities that
are more controlled with less impact such as
swimming, cycling, and walking on cushioned
surfaces. When arthritis becomes more severe, then
the next appropriate step may be medication such
as non-steroidal anti-inflammatories (NSAIDs), or
other types of medications which are usually
prescribed by a rheumatologist. There are many
types of mediations that can be utilized as the
first line of defense for arthritis prior to
considering any surgical procedure.
For patients with stiff and painful joints,
bracing is another form of treatment. The bracing
may be simple, such as a brace that one would
typically use for an ankle sprain. These can
frequently alleviate the symptoms of ankle
arthritis at minimal cost. If this type of brace
is not effective in relieving pain, then an
ankle-foot orthosis (“AFO”) is usually
recommended. An AFO is an individualized brace
that is fashioned by taking specific measurements
of a patient’s foot so that it conforms to that
individual’s foot. This orthosis is usually
designed and fitted to the patient at an orthotics
and prosthetics shop.
Operative Treatment
When all these above measures fail and the
patient still has significant arthritis limiting
lifestyle, then there are three different types of
surgical options that can be undertaken to help
the patient improve their quality of life. If the
joint destruction is on one side of the joint
(asymmetric), then the physician can consider an
osteotomy (or cutting the bone to change the
weight-bearing surface of the joint and help
distribute the weight more evenly). This is
usually not successfully performed in the ankle,
however, it is sometimes considered. The two main
surgical options for arthritis of the ankle are
fusion, called “arthrodesis”, which
permanently stiffens the ankle using screws that
are permanently affixed to the bone, or
replacement of the ankle with artificial parts,
called “prostheses”. Up until a few years ago,
the arthrodesis (or ankle fusion) was the
traditional surgical treatment for ankle
arthritis, because of its ability to relieve pain.
However, this procedure does not leave the patient
with a normal ankle because motion is severely
limited and over time, the joints above and below
the arthrodesis, such as the foot and knee, take
extra stress. Up until approximately five years
ago, there did not appear to be any reasonably
decent ankle replacement components that
demonstrated positive long-term follow-up result.
Over the past ten years, however, a number of
ankle replacement components have gained national
popularity and have achieved similar favorable
results to the total knee replacement components.
One specific ankle replacement component is
currently available at the Hershey Medical Center,
called the Agility Total Ankle System, developed
by DePuy, Inc. (Warsaw, IN) and is FDA-approved.
If you suspect that you may have ankle
arthritis, then you should see your family
physician or internist, as most ankle problems can
be treated effectively with anti-inflammatory
medications and/or bracing. However, if it is
severe enough for surgical intervention, then you
should consider being referred to a foot and ankle
surgeon.
Physician's Who Treat Ankle Arthritis
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
|
