Ankle (and Hindfoot) Arthritis occurs when the cartilage of the ankle (or the joints below the ankle, also known as the hindfoot joints) wear away. Cartilage provides a smooth surface to allow these joints to carry out movement. It also protects and cushions the joints during weight bearing.
An arthritic joint loses its normal shape, and underlying bone is exposed. There may also be formation of bony spurs (or osteophytes) around the joint. It is less common than knee or hip arthritis but can be just as painful and debilitating.
Ankle arthritis most commonly occurs due to previous trauma such as multiple ankle sprains or a fracture (post traumatic arthritis). It may also be the result of long term “wear and tear” associated with your daily activities. Other causes include inflammatory diseases such as rheumatoid arthritis.
‘Standing’ x-rays must be obtained to accurately assess severity of the arthritis. In the earlier stages, it may only be evident on Magnetic Resonance Imaging (MRI) scan.
In many cases, it is appropriate to aim to avoid surgery. Lifestyle and activity modifications such as weight loss and low impact exercises may relieve your symptoms. Over-the-counter preparations such as glucosamine, fish oil and chondroitin may assist with general arthritis type symptoms.
Physiotherapy can help relieve symptoms by strengthening the muscles around the joint.
A visit to the Orthotist or Podiatrist might be useful. They should be able to provide you with advice about footwear and the use of walking aids. They can provide a customised shoe or insole that reduces movement at the painful joint.
In addition, pain killers prescribed by your Doctor to assist in reducing pain should be carefully monitored. Lastly, a cortisone injection has been shown to provide temporary relief.
Surgical treatment is usually left for situations where non-surgical treatment has failed. The aim of surgery is to relieve pain and improve your quality of life. Mr Goldbloom performs a number of surgeries for ankle arthritis and it is important to take time at your consultation to discuss these in order to choose which is option is right for you.
Cheilectomy is a procedure that involves removal of bony spurs (osteophytes). This procedure is very simple and effective in cases where the spur is the major cause of symptoms.
Fusion or Arthrodesis: is often referred to as ‘the gold standard’ for this condition.This procedure involves removing the arthritis by deliberately stiffening the joint. This results in a loss of movement but can provide significant pain relief.
Realignment Osteotomy: this surgery involves reshaping the bones around the joint to redirect your weight-bearing over the non-arthritic part of the joint. Unlike a fusion, it has the benefit of allowing you to continue to move your ankle.
Ankle Replacement: similar to hip and knee replacement, the ankle joint can also be replaced. When compared with ankle fusion, it provides a similar level of pain relief but preserves some pre-operative motion of the ankle.
|Week||Exercises||Boot||Weight bearing||Returning to Pre-Surgical Function|
|0-2||Hip and knee active ROM exercises||Plaster||NWB||Staying home with the foot elevated above heart level for 23 hours a day|
|2-4||Hip, knee, ankle band resisted exercises. Toe AROM – wriggling, flexing, extending. Calf, shin muscles massage.||Cam Boot||NWB|
|4-6||Hip, knee, ankle band resisted exercises. Banded toe exercises – flexion, extension, toe squeezes, spreads, ball squeeze.||Cam boot||NWB|
|6-8||Gentle ankle AROM DF and PF. Calf and shin massage and stretching. Physio guided PF and DF mobilisations. Start DL heel raises, progressing to SL.||Cam boot||PWB progressing towards FWB as tolerated||Return to work – sedentary occupation.|
|8-10**||Physio guided gait and balance training. Continue exercises as above.||Cam boot||FWB if cleared by surgeon|
|10-12*||Increase walking distance.||Cam boot||FWB||Return to light duties – labour intensive occupation|
|12+||Physio guided, gradual return to pre-surgery activities eg. running, cycling.||No boot||May return to full duties (clinical assessment required) Return to sport at ~6 months|
Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Please contact Mr Goldbloom's rooms to discuss if surgery is appropriate for your situation.