Ankle Arthritis    

If you have been diagnosed with arthritis of the ankle, or you experience ankle pain of any sort, call our Seattle office for an appointment. We are able to treat most ankle arthritis in a conservative manner and help patients avoid surgery. Because ankle arthritis can worsen over time, you should be seen as soon as possible if you are experiencing symptoms

What is it?

Arthritis, meaning inflammation of a joint, can occur at any joint in the human body. Because the ankle is a commonly injured joint in the body, patients may experience problems later in life due to the wear and tear (“degeneration”) that slowly occurs over a period of years after an injury. This is one of the reasons that it is so important to be treated appropriately if you ever experience an ankle sprain.

Degenerative arthritis means damage to and inflammation of a joint due to wear and tear. This condition is called osteoarthritis. There are many causes for arthritis, and the term is also used to describe inflammatory conditions, such as gout, infection, and rheumatoid arthritis.

Who gets it?

If you have ever experienced an injury to your ankle joint, you may be at risk for arthritis later in life. In recent years, there has been increasing evidence that some osteoarthritis is genetic and has a tendency to occur in families. Research suggests that osteoarthritis that occurs without any injury may be related to the chemical make-up of the cartilage in the joint.

What are the symptoms?

When the joint sustains an injury, the cartilage holding the joint together becomes damaged. The patient does not typically know that damage has been done, and they may not be experiencing significant pain. When asked if the pain limits their activities, the first answer may be “no”. However, in careful questioning, one would ask a patient “what activities are they doing now that they were doing five years ago that they cannot do now because of discomfort in their ankle”. The patient may be surprised by their response.

In the severely damaged ankle joint, the cartilage tends to rip from the bone. The fragments of cartilage will then float around in the joint causing pain and additional damage. Because cartilage does not heal or grow back, this causes a defect in the joint. Over time, these defects fill with scar tissue, causing more pain and instability to the joint. The joint ultimately reaches a point when it is no longer able to properly function without significant pain because of the continual damage, resulting in increased inflammation and severe pain.

Diagnosis

Your podiatric physician will obtain a family history, considering all factors important in determining the type of arthritis you may have. He will also conduct a thorough physical examination of the ankle joint to evaluate and determine the type and extent of damage to the joint. In this physical examination, the physician will measure the range of motion of the ankle, and may draw fluid from the joint to determine if an infection is present. X-rays will then be taken to assess the amount of damage to the joint and determine the proper diagnosis.

Non-Operative Treatment

At the Foot and Ankle Center of Washington we are experts in conservative treatment of ankle joint conditions. It is our goal to avoid surgery if at all possible. In it’s mildest form, arthritis may not need any treatment whatsoever except simple activity and shoe modification – avoiding impact activities such as jumping – and recommending activities that are more controlled with less impact such as swimming, cycling, and walking on cushioned surfaces. We may also recommend more supportive shoes and either prefabricated or custom orthotic devices.

When arthritis becomes more severe, then the next appropriate step may be custom foot orthotics designed to protect the ankle joint. An orthotic that is made correctly can reduce ankle pain in many patients with ankle arthritis. Very specialized orthotics with several special features designed to offer greater control than standard orthotics are often needed. Standard orthotic devices usually fail to offer optimum relief from ankle arthritis pain.

For patients with stiff and painful joints, bracing is another form of treatment. The bracing may be simple, such as a brace that one would typically use for an ankle sprain. These can frequently alleviate the symptoms of ankle arthritis at minimal cost. If this type of brace is not effective in relieving pain, then an ankle-foot orthosis (“AFO”) is usually recommended. An AFO is an individualized brace that is fashioned by taking a cast of the patient’s foot and ankle. Both of our doctors are experts at fabricating AFOs that are comfortable and effective. If you have worn an AFO in the past and had trouble with it, be aware that today’s AFOs are much more sleek and comfortable than AFOs of even a few years ago.

In addition to foot orthotics or ankle-foot orthotics, shoe modifications can help reduce stress on the ankle joint. In particular, a modification called a “rocker sole” has been shown in studies to significantly reduce stress on the ankle. We can help you determine if a rocker sole is a good option for your condition and if it is prescribe a rocker sole to be added to your shoes. Rocker soles can be added to many different types of shoes.

We also may recommend medication such as non-steroidal anti-inflammatories (NSAIDs), or other types of medications which are usually prescribed by a rheumatologist. There are many types of mediations that can be utilized as the first line of defense for arthritis prior to considering any surgical procedure.

Operative Treatment

When all these above measures fail and the patient still has significant arthritis limiting lifestyle, then there are three different types of surgical options that can be undertaken to help the patient improve their quality of life. If the joint destruction is on one side of the joint (asymmetric), then the physician can consider an osteotomy (or cutting the bone to change the weight-bearing surface of the joint and help distribute the weight more evenly). This is usually not successfully performed in the ankle, however, it is sometimes considered. The two main surgical options for arthritis of the ankle are fusion, called “arthrodesis”, which permanently stiffens the ankle using screws that are permanently affixed to the bone, or replacement of the ankle with artificial parts, called “prostheses”. Up until a few years ago, the arthrodesis (or ankle fusion) was the traditional surgical treatment for ankle arthritis, because of its ability to relieve pain. However, this procedure does not leave the patient with a normal ankle because motion is severely limited and over time, the joints above and below the arthrodesis, such as the foot and knee, take extra stress. Up until approximately five years ago, there did not appear to be any reasonably decent ankle replacement components that demonstrated positive long-term follow-up result. Over the past ten years, however, a number of ankle replacement components have gained national popularity and have achieved similar favorable results to the total knee replacement components.

Don’t live with ankle pain. If you are in the Seattle / Puget Sound area and would like to have your ankle pain treated in the most effective and conservative method possible, call for an appointment in our Seattle office. If you are coming in from out-of-town for ankle pain evaluation and treatment, be sure to let our receptionist know at the time you make your appointment.

A list of articles from the medical literature related to the use of orthotics in treating ankle arthritis is available on our bibliography page.

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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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