Ankle arthritis
Ankle arthritis is a clinical condition in which the joint that connects the foot to the leg, known as the tibiotalar or ankle joint, has damaged or worn out cartilage. There are three bones involved in this joint: the tibia, the fibula and the talus. There are a few medical emergencies with ankle arthritis. Generally this is a chronic condition. If the ankle locks into position and will not move it may be that a piece of bone is trapped in the joint. This would require immediate medical attention. If the ankle is hot and swollen, infectious arthritis may be present, and immediate evaluation is needed. Although not life-threatening, ankle arthritis can significantly limit one's ability to participate in recreational activities, workplace activities and at times activities of daily living. Pain is a common component of ankle arthritis. It is located in the area of the ankle joint and is affected by the level of activity. While ankle arthritis does not cause direct metabolic changes, it may affect the way one walks, which may consume more energy than the person’s normal walking style. This creates fatigue. There are no known dietary components linked directly to ankle arthritis. A healthy well-balanced diet that contributes to overall health helps to improve any chronic condition. In addition, the ankle joint is small, and body weight is concentrated in the small joint surface. Small reductions in overall body weight may have a significant impact on the stress on ankle joint. Weight reduction in general improves the comfort of a joint that bears weight.
Ankle arthritis may occur from wear and tear, as part of a systemic arthritis such as rheumatoid arthritis, or as a result of an injury. The deformity in limb may contribute to excessive wear and tear and early onset of arthritis. For example repeated ankle sprains that result from the foot deformity could lead to arthritis. There is some evidence that a high level of recreational participation in sports is associated with a higher incidence of ankle and foot arthritis. The exact risk factors are not well known. Ankle arthritis is commonly associated with prior fracture of the ankle or any of the bones that make up the ankle joint. It also seems likely that repeated sprains of the ankle may lead to ankle arthritis over time. Ankle arthritis may affect any of the three bones that make up the ankle joint: the tibia, the fibula and the talus. The talus is a small but important bone that connects the foot to the leg. Pain and swelling are the key warning signs of ankle arthritis. It's difficult to predict the progression of the symptoms of ankle arthritis. Some cases progress very slowly, and some may progress very rapidly. There are many small joints near the ankle joint that may mimic ankle arthritis. The closest major joint is the subtalar joint. Because the joints are small and close together and they may be affected by similar activities, it may take specific examination and x-rays to determine which joint is causing the symptoms. Ankle arthritis may occur as a result of wear and tear, injury, or be part of a more widespread arthritis. Ankle arthritis may cause discomfort and swelling. In addition it may affect the foot's inability to move up and down as it would to depress the accelerator in an automobileAnkle arthritis is diagnosed by a combination of the symptoms, physical examination and x-rays or other imaging tests. X-rays are commonly employed to diagnose ankle arthritis. Other tests might be used, such as MRI or CT scan for unusual conditions. When ankle arthritis is a part of a systemic condition, blood tests may be used for its diagnosis. Occasionally a bone scan may be useful. Other tests involving injection of solutions into joints may be employed at times. It's very unlikely that diagnosing ankle arthritis would require any painful procedures or side effects. If some type of injection were to be required, it is usually done by needle stick. While a needle stick may be uncomfortable, it is unlikely to create side effects. A family doctor can often diagnose ankle arthritis. Because there are many structures around the ankle such as tendons and ligaments, and many small joints near the ankle, it may be useful to see a specialist. A rheumatologist is a physician with special expertise in arthritis. An orthopedic surgeon is a physician specially trained to diagnose and treat arthritic conditions. Depending upon the type of arthritis and the complexity of the diagnosis any of these may help you. In addition, physical therapists may be of benefit in the early stages of arthritis.
There are many steps in the treatment of arthritis. The first step is weight reduction and activity modification. Weight reduction is helpful because excess weight causes a magnified increase in weight on the small ankle joint. Activity modification is helpful if specific activities cause the symptoms. If these steps are not helpful, over-the-counter analgesic medications such as acetaminophen are used. Currently, medical treatment is directed at reducing the symptoms of joint inflammation. For many patients weight loss is very helpful, and should be a cornerstone of the treatment strategy. Scientists estimate that for each pound lost, stress on the ankle is reduced by five pounds. The symptoms of joint arthritis can sometimes be relieved with a medicine directed at conserving the remaining joint cartilage. These supplements are not FDA controlled and can be purchased at most pharmacies without a prescription. The most common form is a combination of glucosamine hydrochloride 1500 mg/day and chondroitin sulfate 1200 mg/day. Because the FDA does not consider these to be prescription medicines, the quality of each brand is not strictly controlled, so advice from the pharmacist can help with selecting the product.
In some circumstances, a simple insert is helpful and a brace is not necessary. Pain relief from orthotic management varies and depends on many factors. Often some form of bracing is tried before surgery is considered. When these measures are no longer successful, surgery may be indicated. Surgical treatment options range from minimally invasive surgery up to and including an ankle replacement or ankle arthrodesis. The role of diet in treatment of arthritis is controversial. There is no proven dietary pathway that will reduce active arthritis. Nonetheless a healthy diet that contributes to overall good health will play a positive role in the management of arthritis. In addition, weight reduction is very helpful in the management of ankle arthritis. Because the ankle is a small joint, weight is concentrated in the ankle joint. Small decreases in body weight can have a magnified impact on reduction of symptoms in ankle arthritis. Exercise and therapy may be helpful particularly in the early stages of ankle arthritis. Rest is common and successful method of reducing symptoms. Unfortunately, resting the ankle requires reduction in walking, standing and running. Swimming and cycling may be well-tolerated. The symptoms of ankle arthritis can be reduced for selected patients using physical therapy techniques. Flexibility exercises emphasizing limited or non-impact techniques are most helpful. Pool therapy and aquatic exercises help patients maintain fitness without causing further injury to the ankle joint. Physical therapists can also help patients learn how to properly use a cane to reduce the stress on the arthritic ankle. First-line medication for arthritis of the ankle is similar to that for the hip and knee. Acetaminophen is the first medication employed. A physician may recommend aspirin and NSAIDs such as naproxen and ibuprofen as well. For more severe types of arthritis, other medications may be employed. Disease modifying anti-rheumatic drugs (DMARDS) or biologic therapies may be required for inflammatory types of arthritis. Specific anti-gout therapy may be required for people who have ankle arthritis due to gout. Surgery may be very successful in the treatment of pain and swelling of ankle arthritis. In arthritis that affects only a small part of the joint, surgery may be used to replace a damaged cartilage using cartilage from another part of the body. If arthritis involves the entire ankle, surgery may be helpful to remove painful areas. When arthritis is advanced, ankle replacement with an artificial joint or ankle arthrodesis (fusion) may be used. Arthrodesis is successful and durable but makes the joint permanently fixed. In other words, the joint no longer moves. Removing fluid from the joint with fine needle aspiration may be helpful in diagnosis and may be slightly helpful in treatment. Injection of medication into the joint may be employed a maximum of two times any given joint. Medication placed into the joint by this method may provide symptom relief for up to a few months. The symptoms of joint inflammation can be markedly improved with an injection of a steroid into the joint. Because repeated steroid injections can have a negative long-term effect on the joint, potential candidates are carefully selected.
Braces and splints are helpful in managing ankle arthritis; the more severe the arthritis, the more rigid the brace. Braces may range from soft lace-up braces to hard plastic boots. The brace or splint will limit the motion of the joint and offload some of its stress. In the early phases of arthritis, monitoring symptoms is necessary. As the symptoms become more severe periodic x-ray evaluation may be helpful.
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