Ankle Arthritis Treatment
Arthritis is a term used to describe the destruction of the cartilage in a joint. Cartilage acts as a "ball bearing surface" that allows for smooth painless motion of the joint. Ankle arthritis is most commonly caused by prior injury like recurrent ankle sprains or broken ankle. As the joint degenerates painful bone-on-bone contact occurs causing bone spurs, inflammation, pain, decreased range of motion. As an orthopedic surgeon who specializes in ankle arthritis I discuss all possible treatment options to help alleviate my patients pain. I recommend a full in person evaluation with a foot and ankle specialized orthopedic surgeon including history, physical exam, x-rays of the ankle and foot. Imaging such as CT scans may provide more information to better address your specific problem.
After evaluation, nonoperative treatment options including bracing, anti-inflammatory medications, pain relieving medications, physical therapy, steroid injections can significantly improve pain and function thus avoiding or delaying the need for surgery.
For patients that continue to be limited by painful ankle arthritis after exhausting nonoperative treatments, surgical options should be discussed as follows:
1. Removing bone spurs: In less severe cases, where the joint space is maintained but bone spurs cause impingement with extremes in range of motion, removal of bone spurs or "osteophytes" can be a very helpful option. This can be done both with minimally invasive techniques using an arthroscope or open techniques depending on the size and location of bone spurs. Removal of bone spurs only in a joint with end-stage ankle arthritis is not recommended.
2. Total ankle replacement (ankle arthroplasty):
Similar to the treatment of hip, shoulder, knee arthritis with total joint replacement; total ankle replacement involves removing the degenerated surfaces of the joint and replacing them with metal and plastic (polyethylene) components. Total ankle replacement is growing in popularity in the United States with improvement in longevity/outcomes as improved ankle replacement components are designed. One concern for total ankle arthroplasty is the longevity of the procedure and the potential need for revision surgery down the road. Historically, total ankle replacement has been reserved for more elderly, low demand patients; however, indications continue to expand.
3. Ankle fusion (ankle arthrodesis):
Ankle "fusion" as the process of performing surgery with the intention to make the arthritic/degenerated joint surfaces grow together as one bone. This takes away any range of motion from the ankle joint but is effective in relieving pain related to arthritis. Ankle fusion has long been the gold standard for treatment of ankle arthritis for its pain relieving outcomes. One concern for fusion is the loss in range of motion and potential for the surrounding joints to become arthritic. Historically, the ideal candidate for an ankle fusion is a young active person with ankle arthritis.
How do patients decide on treatment options for their ankle arthritis?
The most important thing patients should do when they have ankle arthritis is educate themselves on the options and to seek professional care from a fellowship-trained orthopedic surgeon who specializes in ankle arthritis. Your foot and ankle orthopedic surgeon could then review the latest research and treatment options that best fit your needs and lifestyle. If surgery is recommended to you for your ankle arthritis, x-ray, CT, or MRI scans may provide your surgeon with the information needed to determine whether you would benefit from surgery.
About Dr. Arena
Dr. Arena is a fellowship-trained orthopedic surgeon foot and ankle / lower extremity specialist. He completed his undergraduate education at Penn State University majoring in Mechanical Engineering with a minor in Bio-Engineering. He then completed his four-year Medical School training at West Virginia University where he earned a Doctorate of Medicine degree (M.D.).
