Anatomy of the Ankle

The ankle joint is where the tibia (shinbone), fibula (outer leg bone), and talus (ankle bone) meet, allowing for the up-and-down movement of the foot. Cartilage lines the surfaces of the bones in the joint, acting as a cushion to absorb shock and facilitate smooth movement. Over time, damage to the cartilage can lead to arthritis in the ankle, causing pain and reduced mobility.

Symptoms of Ankle Arthritis

• Pain and stiffness in the ankle joint, particularly after periods of inactivity.
• Swelling and warmth around the ankle.
• Difficulty walking or performing weight-bearing activities.
• A feeling of instability in the ankle.
• Crepitus (cracking or popping sounds) when moving the ankle.
• Gradual loss of ankle movement.

How is Ankle Arthritis Diagnosed?

Diagnosis of ankle arthritis is typically made through a clinical examination and imaging studies. The key components of the diagnostic process include:

• Physical Examination: The physician will assess the range of motion in the ankle and check for swelling, tenderness, and signs of joint degeneration.
• X-rays: X-rays are often used to evaluate the extent of cartilage loss, joint space narrowing, and the presence of bone spurs.
• MRI or CT scan: In some cases, additional imaging may be required to assess the condition of the cartilage and surrounding structures.

How is Ankle Arthritis Treated?

Treatment for ankle arthritis aims to reduce pain, improve mobility, and maintain function. Non-surgical treatments are typically the first line of management, with surgical options considered in more severe cases.

Non-Surgical Treatment

• Lifestyle and Activity Modification: Reducing high-impact activities (e.g., running, jumping) and incorporating low-impact exercises such as swimming, cycling, and walking can help manage symptoms. Weight loss can also reduce stress on the ankle joint.
• Walking Aids: Using a walking stick or cane can help redistribute weight and reduce pressure on the ankle.
• Medications: Anti-inflammatory medications (e.g., ibuprofen) and pain relievers (e.g., paracetamol) can help manage pain and inflammation.
• Physiotherapy: Physical therapy can improve joint mobility, strengthen surrounding muscles, and alleviate stiffness.
• Orthotics and Shoe Modifications: Custom shoe inserts (orthotics) and modified footwear can help redistribute pressure and support the ankle joint.
• Steroid Injections: Injections of corticosteroids may provide temporary relief from pain and inflammation, though the effects may vary and are often short-lived.
• Biological Injections: Treatments such as glucosamine, PRP (platelet-rich plasma), and stem cell injections have been tried, but their benefits in treating ankle arthritis are unclear, and they are not routinely recommended.

Surgical Treatment

When non-surgical treatments fail to provide adequate relief, surgery may be necessary to manage ankle arthritis. The surgical options include:

• Arthroscopic Debridement: A minimally invasive procedure that involves removing loose debris and bone spurs from the joint using small incisions and a telescope (arthroscope). This can provide temporary relief, though it may not address the underlying arthritis. Patients are typically kept off the ankle for a week and then mobilize with or without a moon boot.
• Ankle Arthrodesis (Fusion): Considered the gold standard for end-stage ankle arthritis, this procedure involves fusing the ankle bones together with plates and screws, eliminating movement in the joint to relieve pain. While the ankle is permanently stiffened, surrounding joints may compensate for some lost motion. Patients typically begin weight-bearing after about 8 weeks, and most achieve a good level of activity, including walking, cycling, and even playing sports like tennis and golf.
• Total Ankle Replacement (TAR): A newer option, TAR involves replacing the damaged ankle joint with an artificial implant. This procedure preserves ankle motion, providing a more natural gait and reducing stress on surrounding joints. While the pain relief is comparable to ankle fusion, TAR has the advantage of maintaining movement. However, TAR implants can fail over time, with around 15-20% requiring revision surgery within 12 years.

Post-Surgical Care

Recovery times vary depending on the type of surgery performed. Typical post-operative management includes:

• Hospital Stay: 1-3 days.
• Non-weight-bearing: 7-10 days, with elevation of the ankle.
• Partial Weight-bearing in a Boot: Begins after 2 weeks (for TAR).
• Full Weight-bearing in a Boot: After 3-4 weeks (for TAR).
• Rehabilitation: Gradual weight-bearing and rehabilitation, with unassisted walking typically achieved within 3-6 months after fusion or TAR.

Prevention of Ankle Arthritis

Preventing ankle arthritis involves protecting the ankle from injury, maintaining a healthy weight, and engaging in low-impact activities to reduce stress on the joints. Wearing supportive footwear and using custom orthotics may also help preserve joint health.

Summary

Ankle arthritis is a degenerative condition that results in the loss of cartilage in the ankle joint, leading to pain, stiffness, and difficulty with mobility. While non-surgical treatments such as lifestyle modification, medications, and physiotherapy can help manage symptoms, surgical options like ankle fusion or total ankle replacement may be necessary for severe cases. With appropriate diagnosis and treatment, patients can achieve significant pain relief and improved function.