Dr. Goldberger: Hi. It's Michael Goldberger. I am one of the foot/ankle specialists at Tri-County Orthopedics. Ankle arthritis is the end result where the protective coating around the ankle joint or cartilage wears away.
There are a hundred different types of arthritis. When most people think of arthritis, they think about osteoarthritis, which is age-related wear and tear. The ankle is also prone to having fractures or strains, and this type of arthritis is called post-traumatic arthritis. Lastly, people who have inflammation or inflammatory arthritis, called rheumatoid arthritis, are also prone to developing changes in the ankle joint.
The people at risk, most commonly, for ankle arthritis, are people that have had previous trauma, whether previous fractures or strains. Also, people who have history of inflammatory arthritis called rheumatoid arthritis, are at particular risk for ankle arthritis. Lastly, and more less common than the hip or knee, osteoarthritis also affects the ankle.
The signs and symptoms of ankle arthritis can be simply pain and swelling, or stiffness of the ankle joint. Over time the patient may notice their ankle changes shape, and the end result is they have difficulty with prolonged walking or standing. Ankle arthritis is most commonly diagnosed by physical examination.
We would expect to see loss of range of motion, swelling of the ankle joint. In addition, you would get X-rays to examine how much cartilage is remaining and look for bone spurs. Rarely, at the very early stages, ankle arthritis is diagnosed by MRI.
Depending on the severity of the ankle arthritis there are several nonoperative choices. First of all, modification of activities is the main stay of treatment. For instance, if you are a runner, maybe doing an elliptical machine or bicycle, is more appropriate. Secondly, a supervised nutritional weight-loss program is appropriate. Next you can use a cane, occasionally an orthotic. Next there are specialized sneakers which compensate for loss of ankle range of motion. In addition pain-relievers or anti-inflammatory medicines may be appropriate. Lastly injections of steroid medications may be appropriate.
In the early stages of ankle arthritis, arthroscopic surgery may be appropriate. Through arthroscopic surgery, we can remove loose fragments of bone and cartilage and even remove bone spurs. In more advanced stages, ankle arthrodesis is appropriate. In this case, the bones are melded together with plates and screws. Lastly, ankle arthoplasty or total ankle replacement is now being used, in select patients.
The postoperative instructions vary with the surgery performed. In someone who had arthroscopy, typically we recommend ice and elevation for two or three days with walking. In someone who had ankle arthrodesis or replacement, due to pain we keep them in the hospital for one to two nights. We recommend elevation above the heart for one to two weeks. And someone who had ankle fusion, they're typically in a cast for about two months. And someone who had ankle replacement, typically we put them in a walking boot and all the range of motions.