Ankle arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Ankle arthritis occurs when there is damage to the articular structures in the ankle due to any number of kinds of arthritis including osteoarthritis, rheumatoid arthritis, crystal induced arthritis, and so on. There are three bones that make up this joint: the tibia, the fibula and the talus.

Arthritis, regardless of type, is characterized by pain and swelling.

Ankle arthritis is generally a chronic condition and is treated supportively, at least in the beginning. Acute inflammatory conditions such as gout or septic arthritis need to be addressed more urgently.

Although not life-threatening, ankle arthritis can significantly limit a person's ability to participate in recreational activities, workplace activities and activities of daily living.

The ankle joint is small, and body weight is concentrated on a small joint surface. Small reductions in body weight may have a profound impact on the stress applied to the ankle joint. Weight reduction in general improves pain.

The leading predisposing factor to ankle arthritis is repeated ankle sprains.

There is some evidence that recreational participation in sports where ankle injury is common is associated with a higher incidence of ankle and foot arthritis.

Ankle arthritis is also associated with prior fracture of the ankle or any of the bones that make up the ankle joint.

The ankle joint actually consists of two closely related joints. They are the tibial-talar joint above and the subtalar joint below.

Ankle arthritis is diagnosed by a combination of symptoms, physical examination and x-rays or other imaging tests such as magnetic resonance imaging.

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.

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 either of these may help you. In addition, physical therapists may be of benefit in the early stages of arthritis.

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.

Weight reduction and activity modification are important. 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. Non-steroidal anti-inflammatory drugs (NSAIDS) either orally or topically can help relieve inflammation.

The symptoms of joint arthritis can sometimes be relieved with 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.

Another helpful treatment is bracing. Inserts and braces can be helpful in the management of ankle arthritis. Selection of the appropriate orthotic requires knowledge of the location of the cartilage loss, the patient’s walking and standing mechanics, and other co-morbid issues. 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 some circumstances, a simple insert is helpful and a brace is not necessary. Pain relief from orthotic management is highly variable.

Removing fluid from the joint with fine needle aspiration may be helpful in diagnosis and treatment. Injection of glucocorticoid medication into the joint may be done a maximum of three times per year. Medication placed into the joint by this method may provide symptom relief for up to a few months.

For more severe systemic 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.

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.

Surgery may be very successful in the treatment of pain and swelling of ankle arthritis. When arthritis is advanced, ankle replacement with an artificial joint or ankle arthrodesis (fusion) may be used. Arthrodesis is successful and durable but limits range-of-motion. In other words, the joint no longer moves. Surgery, unfortunately, is irreversible.

One other option we've done at our center is a stem cell procedure using autologous stem cells (a patient's own stem cells). The short to medium term results are very promising.

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