Do You Think You Have
Ankle Arthritis?

Ankle arthritis is a painful condition. How does it differ from other ankle joint pain conditions? What causes arthritis of the ankle and what are the best treatment options?



Ankle Anatomy

The ankle is comprised of four main bones: the tibia, fibula, talus, and calcaneous. The connection of the tibia and fibula with the talus creates the Talocrural joint. This is the joint most people think of as the ankle joint. This joint allows the foot to move up and down. Another joint is formed between the talus above and the calcaneous below. This is called the Subtalar joint and allows the joint to move side to side. Together these joints also allow the ankle to pronate and supinate.


Ankle anatomy


Like all joints, each bone is lined with a thin layer of cartilage called articular cartilage. Damage to this cartilage can expose the underlying bone, causing inflammation of the joint. This inflammation of the joint is what is referred to as arthritis.



Causes of Ankle Arthritis

Although less common the knee osteoarthritis and hip osteoarthritis , ankle arthritis can occur. Weight bearing joints are much more likely to develop arthritis than non-weight bearing joints.

Similar to the development of other arthritic conditions, previous injury can increase the likelihood of developing arthritis of the ankle. Previous ankle fractures can disturb the articular cartilage leading to increased wear on the joint. Ankle sprains can also lead to instability of the joint leading to increase sheer force across the joint surface.

The mechanics of the foot can also play a role in foot and ankle stress. A foot that pronates is much more flexible and thus can create greater foot and ankle stress, especially if one is overweight or participates in activities that put the ankle under stress.


foot pronation


Typical Symptoms

Arthritis of the ankle is similar to other arthritic conditions. Symptoms specific to the ankle can include ankle joint pain with walking and stair climbing, pain when getting shoes and socks on or off, and occasional symptoms of the joint clicking or catching. As inflammation increases, redness and swelling can occur. The loss of normal range of motion can also be noticed in advanced arthritic conditions.

Symptoms of ankle arthritis are not always consistent. Many times people can experience “good days” and “bad days”. Sometimes there is a fine line between having enough motion and activity that allows the joint to become lubricated and too much motion that creates joint inflammation.


Typical Conservative Treatment

The first step in reducing the pain associated with any arthritic condition is reducing inflammation. The use of ice therapy can be greatly helpful in minimizing ankle joint pain. Of course anti-inflammatory medications are also frequently used (consult your doctor regarding medications). When medication has not been effective in reducing pain, the use of cortisone injections may be recommended.

Reducing joint stress is another means of controlling inflammation. In cases of significant pain, the use of an assistive device such as a crutch or a cane might be necessary. In addition, avoiding painful activity is also recommended in controlling joint pain and swelling.

For controlling foot and ankle stress, shoe selection is extremely important. Although most might think that choosing shoes or shoe inserts that allow for cushioning of the foot would be the best, the opposite is often true. Because softer shoes and insoles allow for greater foot and ankle motion, such choices can actually add to joint pain and inflammation. Rather, shoes and inserts that provide stability are often the best choice.

Another related aspect to helping to minimize ankle joint pain is body weight. Generally speaking, heavier people will have greater stress on joints than lighter people. Thus, whether it be knee, hip or ankle arthritis, reducing body weight will help to reduce joint stress and pain.

Another aspect of conservative treatment is the use of arthritis supplements. Although little research has been performed on the effectiveness of joint supplements specifically on ankle arthritis, there is some evidence that such supplements can help other forms of arthritis (including knee and hip arthritis). Thus for those that cannot or choose not to take medication, supplementation may be a valid alternative to try.


Physical Therapy

Formal physical therapy can be greatly helpful in reducing pain and restoring function associated with arthritis of the ankle. Modalities such as ultrasound, fluido therapy, ice therapy, and whirlpools can help to increase healing and reduce inflammation.

Manual joint mobilizations are also helpful in restoring normal ankle mobility. Arthritis can impact the normal gliding and sliding of joint surfaces, leading to reduced range of motion. Joint mobilizations can assist in helping to restore normal joint mechanics.

Exercise can also play a central role to minimizing ankle joint pain. Our muscles work as shock absorbers thus increasing the strength of the muscles around the ankle can assist in reducing ankle stress.

If you enjoy walking but cannot tolerate it because of pain, water exercise may also be a good exercise choice. Water walking can assist in providing for ankle motion without having to support the weight of the body. In addition, the use of a stationary bike can assist in providing for ankle motion without weight bearing stress.


Surgery

Only in significant cases of ankle joint pain and when conservative treatment has failed should surgery be considered. As with any surgery, obtaining more than one opinion is recommended. Surgical intervention for ankle arthritis is not common. If surgery is warranted, ankle replacement or ankle fusion are generally the surgical options.


Ankle Replacement


Summary

• Ankle arthritis is an inflammatory condition created by the wearing or damage to the articular cartilage of the joint.

• Typical symptoms include ankle joint pain, swelling, limited range of motion, and functional limitation with walking and stair climbing.

• Anti-inflammatory medication, ice therapy, and injections are common treatment choices.

• Shoe selection is specifically important in minimizing ankle joint stress.

• Reducing body weight can help reduce ankle joint pain related to arthritis.

• Supplements for arthritis can be a reasonable option to help minimize ankle arthritis pain.

• Physical therapy can be helpful in reducing inflammation, restoring range of motion, and improving ankle strength and function.

• Only in significant cases and when conservative treatment has failed should surgery be considered.



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References

Curr Opin Rheumatol. 2010 Mar;22(2):223-8.Nonmedicinal therapy in the management of ankle arthritis.Rao S, Ellis SJ, Deland JT, Hillstrom H

Foot (Edinb). 2009 Sep;19(3):171-6. Epub 2009 Apr 28.A review of the differences between normal and osteoarthritis articular cartilage in human knee and ankle joints.Hendren L, Beeson P

Clin Podiatr Med Surg. 2010 Apr;27(2):193-207.Conservative treatments for rheumatoid arthritis in the foot and ankle.Anain JM Jr, Bojrab AR, Rhinehart FC

Bull NYU Hosp Jt Dis. 2011;69(1):27-35.Total ankle arthroplasty.Park JS, Mroczek KJ


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