Ankle arthritis leads to pain and swelling in the ankle joint. Symptoms are often aggravated by standing and walking, and patients often walk with a limp. Ankle arthritis commonly results from a history of trauma to the ankle; either a severe ankle injury, such as a bad ankle fracture, or a series of recurrent injuries to the ankle. However, it may develop from other causes, such as uneven loading of the ankle joint due to an alignment deformity; inflammatory arthritis, such as rheumatoid arthritis; crystal arthritis, such as gout, or secondary to a serious joint infection. Patients with severe ankle arthritis will often have limited ankle motion and may have a grinding sound when they move their ankle joint. Ankle arthritis is commonly associated with loss of cartilage from the ankle joint, which will show up on a weight-bearing ankle x-ray (Figure 1). Non-operative treatment is designed to improve function and decrease pain, and is based on: limiting the amount of loading through the ankle joint (weight loss, activity modification, cane, etc.); masking the symptoms (anti-inflammatory medication, pain medications); and decreasing ankle joint movement (ankle bracing, rocker-bottom shoewear). Operative treatment may be helpful if non-operative treatment is unsuccessful. Common operative treatments include cleaning out (debriding) the ankle joint if the ankle arthritis is not severe, or ankle fusion for patients with severe arthritis. Ankle replacement may be an option for older patients who are not excessively active.
Ankle pain, stiffness and swelling are characteristic symptoms of ankle arthritis. Pain is often aggravated by activities, such as standing and walking. “Start-up” pain, such as when a patient has pain and stiffness in the ankle after sleeping or sitting in one spot for a while, is also a common complaint. When this occurs, it often takes the patient a few minutes (or longer) to “warm-up” the ankle. The ankle will tend to swell more as the day progresses, particularly if there is increasing activity. Pain is often experienced throughout the ankle, although it may be more noticeable at the front of the ankle if large bones spurs have formed. Ankle arthritis occurs when there has been damage to the joint cartilage that normally covers the bones of the ankle joint. Loss of cartilage leading to ankle arthritis can occur from a variety of causes including:
On physical examination, the patient will often have ankle swelling relative to the opposite ankle. There is likely to be a restriction in ankle motion, which may be associated with cracking or popping. Patients may walk with a noticeable limp.
Ankle arthritis can be diagnosed on plain ankle x-rays (Figure 1). X-rays performed with the patient weight bearing will demonstrate:
In subtle cases, or if there are other questions that need to be answered, it may be necessary for the treating doctor to order an MRI or a CT Scan of the ankle and hindfoot.
There is non-operative and operative treatment for ankle arthritis. The goals of treatment are to minimize pain and discomfort, and to improve function. The type of treatment will depend on both the patient’s symptoms and the extent of the ankle arthritis. Often, non-operative treatment can be successful in significantly decreasing symptoms. Many of the non-operative treatment approaches can also be helpful in conjunction with surgery.
There are a variety of non-operative treatments. These treatments are designed to:
In certain patients with ankle arthritis, surgery may be beneficial. Surgical options include:
Potential Surgical Complications: Any surgical procedure may lead to a surgical complication. Procedures to address ankle arthritis are no exception!