Ankle Arthritis

A Patient's Guide

Ankle arthritis is a condition characterised by inflammation and degeneration of the ankle joint, leading to pain, stiffness, and reduced mobility. It can result from various causes, including injury, gradual wear and tear, and autoimmune diseases. Unlike the more common hip and knee arthritis, ankle arthritis is less frequently discussed but can be equally debilitating. Understanding its symptoms, how it is diagnosed, and the available treatment options is crucial for managing the condition and maintaining a good quality of life.

Symptoms and Signs

The symptoms of ankle arthritis can vary in severity and may develop gradually or suddenly. They include:

Pain: This is the most common symptom and typically worsens with activity and eases with rest. It is usually felt deep within the joint and can be aggravated by walking, running, or even standing for extended periods. The pain can vary from a dull ache to a sharp, stabbing sensation.
Swelling: This occurs around the joint and may fluctuate with activity levels. It can make the ankle appear puffy and tender to touch.
Stiffness: Patients often experience difficulty moving the ankle, especially after periods of inactivity, such as in the morning or after sitting for a long time. This stiffness can limit the range of motion and make it difficult to perform everyday tasks.
Reduced Mobility: As arthritis progresses, the ability to move the ankle diminishes. Patients may find it challenging to walk, climb stairs, or engage in physical activities. This reduced mobility can lead to muscle weakness and changes in gait, further exacerbating the problem.
Deformity: In advanced cases, the joint may become deformed from the wearing down of cartilage and changes in the alignment of bones. Deformity can lead to an uneven distribution of weight and increased stress on other parts of the foot and leg.

Investigations

Accurate diagnosis of arthritis involves a combination of history, physical examination and imaging studies. This is critical for effective treatment planning. Investigations include:

X-rays: These are the most commonly used imaging modality for diagnosing arthritis. They can reveal joint space narrowing, bone spurs, and changes in bone structure. X-rays are particularly useful for assessing the severity of arthritis and monitoring its progression over time.
CT Scans: They offer detailed cross-sectional images of the ankle joint and are useful for assessing complex cases of arthritis. They provide a clearer picture of the bone anatomy and can help in planning surgical interventions.
MRI (Magnetic Resonance Imaging): MRI provides more detailed images of the soft tissues, including cartilage, ligaments, and tendons. It is particularly useful in the early stages of arthritis when cartilage damage might not be visible on X-rays. MRI can also help identify other potential causes of ankle pain, such as ligament injuries or stress fractures.
Blood tests: In cases where inflammatory or autoimmune arthritis is suspected, blood tests can help identify markers of inflammation or specific antibodies, such as rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) that may suggest rheumatoid arthritis.

Non-surgical Treatment

Non-surgical treatments are often the first line of management for ankle arthritis. These approaches focus on alleviating symptoms and improving joint function without the need for invasive procedures. This typically involves:

Painkillers: Painkillers, such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce pain and inflammation. In some cases, corticosteroid injections may be administered directly into the joint to provide temporary relief from severe symptoms.
Physiotherapy: A tailored exercise program can help improve range of motion, strengthen the muscles around the ankle, and enhance overall joint function. Therapists may also use modalities such as heat, cold, and ultrasound to alleviate pain and inflammation.
Bracing and orthotic devices: These can provide support and stability to the ankle joint, reducing pain and improving function. Custom-made shoe inserts can help redistribute weight and alleviate pressure on the affected joint. Rocker soled shoes are widely available and allow the shoe to do more of the work of moving rather than the ankle.
Lifestyle modifications: Weight loss where appropriate can reduce the stress on the ankle joint, while avoiding high-impact activities such as running can help prevent further damage to the joint.

Surgical Treatment

When non-surgical treatments fail to provide adequate relief, surgical intervention may be necessary. Several surgical options are available, depending on the severity of the arthritis and the patient's specific needs. Surgical options include:

Arthroscopy: This is a minimally invasive procedure that involves inserting a small camera and instruments into the joint through tiny incisions. It can be used to clean out loose fragments, smooth rough cartilage, and address other joint issues. This procedure is occasionally recommended for early-stage arthritis.
Osteotomy: Cutting bones to realign them may redistribute weight and alleviate pressure on the arthritic joint. This procedure can help delay the need for more extensive surgery, especially in younger patients with localised arthritis.
Fusion: This involves permanently joining the bones of the ankle to eliminate movement in the arthritic joint. This procedure can provide significant pain relief and improve stability, but it also results in a loss of joint flexibility.
Ankle replacement: Replacing the joint is a surgical procedure in which the damaged joint surfaces are replaced with artificial implants. It is an alternative to fusion in some patients. Whilst mobility is preserved, the implants may wear out over time and a detailed discussion to discuss the merits and risks is important prior to surgery.

Summary

Ankle arthritis is a debilitating condition that can significantly impact daily activities and quality of life. Early recognition of symptoms and timely diagnosis through clinical evaluation and imaging studies are essential for effective management. A comprehensive approach to treatment, including both non-surgical and surgical options, can help alleviate symptoms, improve joint function, and enhance overall well-being. With proper care and management, individuals with ankle arthritis can lead active and fulfilling lives.