The tibia and fibula and the ankle bone talus form the ankle joint. This joint allows the foot to move up and down. The sideways movement of the heel principally occurs in the three joints (triple joints) under the talus (sub-talar, talonavicular and calcaneocuboid joints). Smooth articular cartilage covers the bones to allow them to freely glide over one another as the joints move.
Most commonly associated with previous injuries, osteoarthritis may occur spontaneously in the ankle joint. Severe sprains or repeated sprains can damage the articular cartilage of the ankle and lead to progressive arthritis as can fractures around the ankle joint.
The symptoms of ankle arthritis may present as: -
- Stiffness and pain caused by roughening of the joint surface
- Inflammation can cause swelling of the ankle joint
- Early stages - discomfort during exercise which settles with rest
- Later stages - standing or walking becomes painful, and eventually, pain is experienced even at rest
- Severe arthritis, the joint surface can erode which may lead to a deformity of the foot with the heel turning in or out when standing.
Non-surgical treatments for ankle arthritis
There are many non-surgical treatments that should be tried before surgery. These include:
- Diet - Losing weight will reduce the strain on your ankles
- Medication - Painkillers such as paracetamol or ibuprofen can reduce the pain. Ice packs can help reduce swelling
- Exercise - Physiotherapy helps build the strength of the muscles, which can take the strain off the joint. We understand that exercise can be painful but you can choose from many non-impact activities such as swimming or cycling
- Activity modification - Avoid running, squatting and carrying heavy loads. If you are still working, consider changing your role at work
- Ankle Supports - There are many different types of ankle braces and your physiotherapist can help you find the best option for you
- Footwear adjustment - Supportive boots, modified shoes or corrective insoles may help
- Walking aids - A walking stick or cane can be very helpful
You will only be offered surgical treatment if most or all of the above non-surgical measures have failed to control your symptoms, at which point you are considered to have ‘end-stage ankle arthritis’.
Surgical Treatments for ankle arthritis
The diagnosis of ankle arthritis is usually made by a specialist orthopaedic foot and ankle surgeon, based on a history of your condition as well as a careful examination, and a series of standing (weight bearing) X- rays. The X-rays may show a loss of the normal joint space as well as other signs of arthritis.
In most cases, a standing X-ray of the affected foot is all that is needed to determine the severity of arthritis but sometimes it is necessary to carry out further tests such as MRI (Magnetic Resonance Imaging) or CT (Computerised Tomography) scan to look for arthritis of the adjacent (surrounding) joints.
Your specialist may also recommend image-guided injections into one or more joints in order to localise the symptoms and judge the effect that numbing a joint has on your pain.
If you have not previously been diagnosed with a rheumatic condition, your specialist may also order some additional blood tests (to look for conditions such as rheumatoid arthritis or gout).
The cause of ankle arthritis (osteoarthritis) is the end result of the cartilage wearing away.
In primary osteoarthritis, there is no known cause, but it may run in your genes. You and your parents may have swollen painful fingers (Heberden’s and Bouchard’s nodes), and your parents might also have been diagnosed with similar symptoms at a similar age to you.
The majority of ankle arthritis (OA) follows trauma or injury, although inflammation (such as rheumatoid arthritis) can also be a cause. Over 29,000 cases of symptomatic ankle OA are referred to a specialist foot and ankle surgeons each year in the UK.
The ankle is injured more than any other joint. Indeed ankle sprains are one of the most frequent reasons for attending Emergency Departments. The incidence of ankle fractures is increasing especially in young athletes and elderly females. After an unstable ankle fracture, radiographic ankle OA can occur in up to 66% of patients within six years.