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There are many forms of arthritis, or joint disease/inflammation, but the most common types that affect the foot and ankle include osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
Osteoarthritis is from general “wear and tear” of the joint cartilage that will cause pain with motion. It is essentially a rough surface gliding over another rough surface with joint motion or with standing and walking. With ankle osteoarthritis, patients may have deep ankle pain, feelings of “catching or locking” of the ankle joint, or even ankle instability. They may notice progressive deformity of the ankle and swelling. X-rays may show narrowing of the joint space that represents worn out cartilage and even bone spurs, or the body’s natural attempt to decrease the painful motion of the joint.
Rheumatoid arthritis is the most common type of autoimmune arthritis. Patients are diagnosed with clinical and radiographic examination as well as with blood tests. For rheumatoid patients with ankle involvement, they experience more inflammatory symptoms with joint pain and swelling, and less mechanical symptoms compared to osteoarthritis. X-rays generally show joint space narrowing and joint effusion or swelling.
Post-traumatic arthritis of the ankle usually has a clear history of ankle trauma involving the joint or even resultant deformity. Similar to malalignment of the tires on a car and accelerated tire wear, deformity near the ankle can result in accelerated joint wear and post-traumatic arthritis. These patients may have had surgery in the past and retained hardware near the ankle, that may also cause pain due to prominence. Post-traumatic ankle arthritis is similar to osteoarthritis, and is pain related to joint motion and standing/walking. X-rays may show ankle hardware, deformity, and joint space destruction.
The treatment of ankle arthritis is tailored to the individual patient and the underlying cause. Conservative management may include:
If nonoperative management fails, surgery may be indicated.
Surgical management of ankle osteoarthritis may begin with ankle arthroscopy, to scope the joint and clean any loose bodies, clean up the cartilage, and remove bony spurs that may be painful. If medications fail for rheumatoid patients, ankle arthroscopy may also be indicated to clear the inflammation and clean the cartilage. For patients with post-traumatic ankle arthritis, hardware removal may help as well correction of any ankle deformity that may cause uneven wear of the joint cartilage. Again, ankle arthroscopy may help.
More aggressive surgical management of ankle arthritis includes ankle fusion and total ankle replacement. Ankle fusion, or arthrodesis, involves surgery to remove the worn out joint cartilage of the ankle and fuse the bones across the ankle joint together. The ankle joint will no longer have motion, and thus will no longer be painful. This is the gold standard and patients generally do well since they began with little or no motion of the ankle joint from the arthritis anyways. In general, patients should change their shoe wear to accommodate the ankle fusion and minimize changes of their gait.
Lastly, total ankle replacements have become a viable option with great success, although not as common as total hip and knee replacements. For patients without significant ankle deformity, the worn out cartilage is surgically removed and metal and plastic implants are inserted to act as the new and painless ankle joint. This preserves and may even increase ankle joint motion.