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Ankle Arthritis Has Both Surgical and Non-Surgical Treatment Options

Timothy Rearick, MD Orthopedic

Joint pain has many sources, but one of the most common is arthritis—a breakdown of the smooth cartilage surface that lines the bones in our joints and enables them to glide against one another when we move. As cartilage continues to wear away, the resulting bone-on-bone contact can lead to inflammation in the joint, causing pain. There are several forms of arthritis, but in the ankle joint, post-traumatic arthritis is the culprit in roughly 75 percent of cases.

Sports injuries, motor vehicle accidents and even a simple fall are among the common events that can cause injury to the ankle bones, ligaments or other supporting structures. These injuries sometimes directly damage cartilage cells, or they may redistribute the weight-bearing forces in the joint and lead to destruction of the cartilage—both of which can eventually create the conditions for post-traumatic arthritis.

Patients typically describe arthritis as a dull ache within the joint. In ankle arthritis, this ache usually first shows up following some sort of increased activity, such as running, jumping or other high-impact activities. As the condition worsens, even simple movement can create considerable pain.

If you find yourself relying on anti-inflammatory medication more frequently than usual and/or if you’re experiencing stiffness or loss of flexibility in your ankle, it is probably time for you to see your doctor to find out what’s going on. Your doctor will likely start with an X-ray to look for narrowing in the space between the joints, the presence of bone spurs and other subtle signs of arthritis. From there, you may need to have other imaging procedures to provide further information.

Like most physicians, my approach to treating arthritis is a conservative one, almost always beginning with non-surgical options that accommodate for the arthritis as best as possible. Initial treatment may include behavior and activity modification, anti-inflammatory medication for pain relief and, most important, weight loss. In fact, multiple studies have proven that weight loss slows the progression of arthritis.

If those approaches don’t bring enough relief, the next step is usually advanced non-surgical options, including injection of corticosteroids to decrease inflammation and pain. Unlike anti-inflammatory medications that are taken orally, corticosteroids can be injected directly into the joint. Your physician may also recommend viscosupplementation, an injection of lubricating fluid into the ankle joint in an attempt to restore the gliding properties of the joint. The final non-surgical treatment measure is to try to brace the joint to provide support and relieve discomfort.

In cases where the arthritic pain and stiffness continue even after these non-surgical approaches, your physician may discuss surgical options with you. In early arthritic conditions, sometimes a simple arthroscopy and joint cleanup is all that is needed. However, in more advanced ankle arthritis, there are two main types of surgery: ankle fusion and ankle replacement.

Ankle fusion has been performed for many years and has been considered the gold standard in surgical treatment for ankle arthritis. As the name implies, the two bones of the joint are permanently joined together. Patients can return to many of their activities (except for high-impact movements), and complication rates for this surgery are typically low. One disadvantage of this option is that, at times, patients develop arthritis in the bones of the foot that compensate for the change in the ankle joint. Although patients lose the motion in a fused ankle joint, many already have little motion because of the advanced stage of their arthritis.

In contrast, ankle replacement enables patients to retain motion in their ankle joint, and ankle replacement is preferable to fusion for climbing stairs and doing other activities on an incline, such as skiing. However, ankle replacement is not an option for everyone. Currently, it is not recommended for patients younger than age 45, patients with diabetic or peripheral neuropathy, patients with significant deformity, and those who have no motion left in their ankle joint. (Ankle replacement provides only the amount of motion present before surgery; it doesn’t restore lost motion.)

Ultimately, both surgical and non-surgical treatment options are aimed at decreasing ankle pain and returning patients to their daily activities. If ankle pain is keeping you from enjoying life, do yourself a favor by making an appointment with your physician.

Timothy Rearick, MD, is an orthopedic surgeon with the Ventura Orthopedic Medical Group and is on the medical staff at Simi Valley Hospital.