Arthritis is a general term for a group of more than 100 diseases.
“Arthritis” means “joint inflammation.” When it affects the ankle joint it can produce swelling and pain, and may eventually result in deformity, loss of joint function, and decreased ability to walk.
The most common form of ankle arthritis is osteoarthritis.
CAUSES
Common causes of ankle arthritis include:
• Rheumatoid arthritis: An inflammatory disease affecting the lining of joints and destroys bones, joints and tissues. The condition often starts in smaller joints, like those found in the foot or ankle.
• Previous injury: In patients who sustain an ankle injury, such as a fracture, the cartilage may be damaged and lead to arthritis.
• Infection: Infections of a joint can damage cartilage cells. Because cartilage cells cannot regrow, the damage from an infection can be permanent.
• Genetics: Some people have a genetic tendency to wear out joints faster than others.
• Obesity: Patients who are overweight place a larger burden on their body's joints. These patients have more of a tendency to develop arthritis, and often have more accelerated damage to the joint cartilage.
DIAGNOSIS
We will perform a visual inspection and take your health history. X-rays may offer valuable information. The key for treatment is to understand the progression of the disease and when symptoms first appeared.
SYMPTOMS
Regardless of the reason causing the Arthritis, many people report the same set of symptoms: swelling, stiffness, tenderness, pain and loss of flexibility. Ankle arthritis can produce ankle swelling and pain and in severe cases it can cause loss of function. An estimated 50,000 people a year experience end-stage ankle arthritis, in which the ankle cartilage has worn away completely, causing painful bone-on-bone contact and some level of disability.
TREATMENT
Sometimes simple conservative treatment can alleviate the majority of ankle arthritic pain. Pain relievers, anti-inflammatory medications and corticosteroid injections can be used for temporary relief. Choosing an ankle brace or orthotic inserts can help strengthen the muscles that support the joints. If the disease has progressed to a point requiring surgical intervention, there are three options:
1. Ankle Arthroscopic Debridement may relieve symptoms if joint damage hasn’t progressed too far.
2. Ankle Fusion Surgery (Ankle Arthrodesis) involves fusing bones together (tibia and talus) with the use of pins, screws, plates or rods. After healing, the bones remain fused together, eliminating full motion in the ankle. About 25,000 ankle fusions were performed in the United States last year. Ankle fusion is suitable for young or very active individuals with bad ankle damage. For those patients with severe arthritis or joint damage, ankle fusion can be a reliable solution for pain relief and improving function. Surgery is typically quite successful, however as with any surgery, there is a risk the bone will not fully heal together. There are several things that influence the healing including remaining completely non-weight bearing, limiting motion, and cutting out tobacco products. As you recover, you will be prescribed physical therapy when it is safe to put weight on your foot. Therapy will help you regain strength in your foot or ankle and restore range of motion. Patients can usually return to normal daily activities in 3 - 4 months. Full recovery takes four to nine months, depending on the severity of your condition before surgery, and the complexity of your procedure.
3. Joint Replacement Surgery (Ankle Arthroplasty) involves replacing the ankle joint with artificial implants made of metal alloys and lightweight plastic. Growing in popularity and covered by Medicare, it is expected that joint replacement will become more standard protocol as we make strides towards improved technology for a wider range of treatment. Artificial ankle joints are far more sophisticated and effective than past devices. Current ankle devices (such as the STAR Ankle) also have more maneuverable components for better joint function, and the materials are much more durable than before. In a survey, when patients were asked to compare their arthritis symptoms before and after surgery, those with artificial ankles reported a far superior range of motion. Studies show that people with severe ankle damage from rheumatoid arthritis and gout also benefit from ankle replacement. The key to successful joint replacement is making sure that you are an ideal candidate for the procedure. Dr. Smith can help you decide if you meet the parameters for successful joint replacement
