Ankle Arthritis

Do you experience pain in and around your ankle? Ankle stiffness? Ankle swelling?

Ankle Arthritis: What is it?

Arthritis is a general term used to describe the deterioration of a joint. Typically joints are covered with a smooth hyaline cartilage which allows for pain free motion of the joint. The surfaces can wear out for a number of reasons and leave exposed bone in the joint which can cause pain. This is typically referred to as “degenerative arthritis”. The ankle, like other joints such as the hip and knee, can wear out with time and lead to pain, particularly with activity.

Symptoms: What does Ankle Arthritis feel like?

Typically, ankle arthritis causes pain with loading the joint (i.e. walking or running). The pain is generally along the front of the ankle. It can often lead to stiffness with range of motion of the ankle joint, when the arthritis is advanced. It can also lead to ankle swelling and soft tissue tenderness, and occasionally even pain at rest.

Causes

The causes of ankle arthritis are varied, but can usually be divided into two groups: 1) inflammatory arthritis, which includes rheumatoid arthritis, and 2) degenerative arthritis, which is basically the wear and tear of every day life.

Inflammatory arthritis, which includes rheumatoid arthritis

Degenerative arthritis, which is basically the wear and tear of every day life.

Evaluation: How is Ankle Arthritis diagnosed?

Evaluation begins with a physical examination of the extremity, and radiographs (X-rays). An X-ray will often show narrowing of the joint, suggestive of thinning cartilage, and show any deformity of the joint. A CT scan can sometimes be helpful to evaluate the extent of arthritic bone cysts, or an MRI to assess the damage to the cartilage in early cases.

Treatment

Treatment starts with activity modification and exercise to try to get near one’s ideal body weight. Use of anti-inflammatory medication, good nutrition, and healthy choices can also be helpful. Braces, such as an Arizona AFO, can often times alleviate the pain before a surgical option is chosen. Cortisone injections an also give temporary pain relief. Corticosteroids can reduce inflammation, swelling and pain

Surgical Options

Surgical options primarily include arthroscopic debridement of offending bone spurs, as well as ankle fusion, or ankle replacement.
Ankle arthroscopy involves placing a small camera in the joint and with the use of specialized tools, the bone spurs (osteophytes) are debrided, alleviating impingement and pain. It can also be used to smooth the damaged cartilage edges and help with the pain and swelling temporarily.
Ankle fusion is an option for end stage ankle arthritis if a patient’s disease has failed conservative treatments. A fusion requires bone grafting between the joint surfaces, tibia and talus, as well as stabilizing the joint with screws rods or plates.
Ankle replacement is a surgery where the joint surfaces are replaced with a metallic implant and plastic bearing surface, similar to a knee or hip replacement. The surgery requires making precision bone cuts in the tibia and talus, then implanting the prosthesis and allowing bone to grow into the metallic surface. The surface between the metal implants is a plastic bearing surface (polyethylene) that allows the ankle to move smoothly.

Recovery: What Can Be Expected?

Ankle arthroscopy recovery is typically a few days on crutches or a walking boot, then physical therapy to get back into your regular shoes after a couple of weeks. The ankle fusion surgery is non-weight bearing for 6-8 weeks, and can then transition to a walking boot for another 4-6 weeks, depending on the bone quality and type of fixation. Ankle replacements are also typically non-weight bearing for the first 6 weeks, then a walking boot for another 4 weeks, before transitioning to good supportive shoes. All of these surgical options benefit from good post operative care and treatment to help control swelling, improve range of motion if needed, and to strengthen the surrounding muscle groups.

Frequently asked questions about Ankle Arthritis

How do I know if I need ankle arthritis surgery?

This really comes down to pain. Typically patients are experiencing pain, swelling, catching in the joint, or joint locking or giving way.

Are you awake for ankle arthritis surgery?

Often times this is done either under a spinal block, when the patient is awake, but the legs are numb during the procedure. Or a general anesthetic can be used, where the patient is asleep for the surgery. Either of the options are reasonable and the benefits will be discussed with your anesthesiologist.

How long will I be out of work after surgery?

This really all depends on your work environment. Typically patients are kept non-weight bearing on the leg for the first 6 weeks. Accommodations for the extended period will need to be made.

How painful is ankle replacement or fusion surgery?

The pain after surgery is very manageable with the post operative pain protocols available. Most patients get a popliteal block after surgery. This consists of a small catheter that is placed below the skin near the nerves supplying the foot and ankle. The catheter is hooked to a small plastic bulb filled with numbing medication. This will actually help with post operative pain control for the first couple days after surgery and will allow much less need for pain medication. I think this has really revolutionized how we treat patients post operatively from a pain standpoint.

Physicians

The following physicians specialize in the treatment of Ankle Arthritis:

Gregory F. Alvine, MD

Gregory M. Neely, MD

Dustin P. Collins, MD

Eric S. Watson, MD

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Testimonials

I went to Dr. Watson with a lot of foot pain. He guided me through the process of healing. His office is connected with great physical therapists that were able to assist me in buying the correct shoes and orthotics. They made a great team in helping me walk comfortably again. I was happy to avoid surgery.

I had similar surgery on my other ankle several years ago with another doctor so I was hesitant going into this surgery but this went a 100 times better. Very pleased so far with the results and he and his whole staff are outstanding.

I broke my lower leg bone in my ankle on Saturday, Dr. Watson was able to see me on the following Monday. I had my surgery the next day. I have been more than happy with Dr. Watson and his staff. I was able to have open discussions about what to expect and how the treatment will go. I have nothing but positive testimonials for the service I’ve received. I highly recommend Dr. Watson and his staff. Top notch!