By Brad D. Dresher, MD
As an orthopedic surgeon, I frequently encounter seniors who enjoy daily walks, runs or hikes. An unfortunate outcome for a lifetime of activity is the development of arthritis. The most common type of arthritis is osteoarthritis (OA)—a non-inflammatory joint disease characterized by a degeneration of the articular cartilage. OA afflicts approximately 10% of the population in the United States and Canada. One particular type of OA that can be life altering is ankle osteoarthritis. While seemingly debilitating if left untreated, several options exist for symptom management and overall treatment.
Ankle OA is a degenerative joint disease that most often results from repeated wear and tear of ankle cartilage over an extended period of time. Hence, most people develop OA later in life. It can also be caused by complications from ankle fracture(s) or multiple episodes of ankle trauma including severe sprains. This type of arthritis is considered post-traumatic OA.
The primary and most common symptom of ankle arthritis is pain. Patients typically report pain in the anterior ankle with weight bearing and the “push off” action while walking or climbing stairs. Other symptoms include swollen joints, joint tenderness and stiffness. Where pain is present, it will usually worsen with exercise. Still, not everyone with ankle OA experiences pain. Some simply notice a crunching feeling or sound, or grating sensations at the ankle. Creaking, clicking, or snapping can also occur. Joint stiffness is often noticeable in the morning upon getting out of bed. Joint locking usually becomes worse in damp or cold weather. Symptoms may become more severe after periods of inactivity. One may also notice a change in ankle position while standing compared to the other unaffected ankle.
The diagnosis of ankle osteoarthritis is most frequently made with weight bearing x-rays of the ankle, which help an orthopedic surgeon evaluate joint-space narrowing and ankle alignment. Consideration should also be given to weight bearing x-rays of the foot to assess foot alignment.
Once the diagnosis is made there are several options available for treatment. These potential treatments include both conservative (non-surgical) and surgical options.
Conservative treatment generally includes activity modification. An example would be changing exercise patterns from walking or hiking to swimming or biking. Another option which may relieve ankle pain is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). If long-term use is expected, patients should be screened for contraindications. Furthermore, intra-articular injections of corticosteroid-anesthetic combinations can be used to decrease joint pain and inflammation. Injections should be at least 4-6 months apart. Your doctor may also consider a shoe with a cushioned heel and a stiff, rocker-bottom sole. For more severe cases, a customized brace may be appropriate. This brace restricts ankle motion, decreases inflammation and relieves pain during activity. It may be worn at all times even during exercise.
Surgical options include an arthroscopic ankle-joint debridement. This procedure may temporarily relieve the symptoms of early ankle arthritis. During this procedure your orthopedic surgeon will evaluate the condition of the articular cartilage, remove any loose fragments of cartilage or bone and trim bone spurs. Further surgical options include a total ankle arthroplasty—which replaces all damaged articular surfaces with orthopedic implants. Removing the damaged tissue allows pain free ankle motion. This procedure is better for elderly patients with end-stage arthritis and normal ankle bony alignment. It should be carefully considered before undertaken as long-term follow-up on new designs of ankle implants is needed to determine advantages over other surgical treatments.
The final surgical option is an ankle fusion. An ankle fusion eliminates all painful ankle motion. This procedure is performed by removing all remaining damaged tissue and fixing the ankle in a position of function—ultimately sacrificing ankle movement for the elimination of pain. This procedure may be performed through an ankle scope as described above or it may be performed as an open procedure. As with any surgery, there exist potential complications which should be carefully discussed with your surgeon.
In summary, ankle arthritis can be a devastating problem to those who are used to a life full of activity. However, there are several treatment options that can improve your quality of life and allow you to return to your healthy active lifestyle. If you are experiencing related symptoms and suspect ankle arthritis, please consult an orthopedic surgeon for proper diagnosis and treatment.