The Foot and Ankle in Motion
The ankle, including its relationship to the foot is a magnificent machine specialized to adapt to the terrain and efficiently move us forward. Our feet support two to six times our body weight as we walk and run. However tolerances are small and as mileage increases (with age) subtle changes in alignment and range of motion may have significant effects. These changes directly influence how forces are applied to the foot and ankle when in motion.
Arthritis is the wearing away of joint cartilage, and the formation of bone spurs. Joint cartilage is specialized tissue that resists wear and tear associated with the repetitive stress of weight bearing activity. This tissue does not have the ability to regenerate, rather cartilage can continue to degenerate. Then irritation results in pain and inflammation in and around the joint. Joint irritation also stimulates the reaction of bone growth or spurs, which are growths forming at the joint edges that can further restrict motion and cause pain. Typically, the pain associated with arthritis is proportional to the individual’s activity and tends to worsen at the end of the day.
Treatment depends on the stage of the disease process and the impact it has on ones lifestyle. Early on, the focus includes bracing, physical therapy and regular exercise to keep muscles supple and alleviate stress in the ankle and improve function. Surgically correcting the alignment above and/or below the ankle joint, thereby preserving the joint itself, can improve the longevity of the ankle joint.
In more advanced cases bracing is less successful but still an option. Surgical treatment of end-stage arthritis consists of fusing or replacing the ankle joint. Fusion trades joint motion for pain relief. Ankle replacement can be beneficial in patients who have end-stage changes but maintain good motion. All things considered, the decision to have such a surgery is not dependant on the x-ray appearance but the impact this process has on quality of life.