I Have Arthritis In My Ankle. What Can I Do?

Ankle arthritis is one of the most common problems seen in a
rheumatology office. While it is a relatively small joint
complex, it is subjected to a great deal of stress because of
the weight-bearing required with standing and walking.

Throw in the need to make forward and backward movements as
well as side to side movements, it becomes clear that the stress
placed on the bones, ligaments and tendons is tremendous. And
that doesn't even account for the twisting and [pivoting motions
that are often required during a typical day.

Because of this responsibility and location, ankles are
probably injured more than any other joint complex.

Many different kinds of arthritis can affect the ankle. The
most common are osteoarthritis. Osteoarthritis is a wear and
tear type of arthritis. The cartilage that cushions the joint
begins to wear away prematurely as a result of trauma and
localized inflammation. This type of osteoarthritis that occurs
following injury is referred to as post-traumatic
osteoarthritis. A common scenario is someone who sprains their
ankle as an adolescent or young adult and then develops ankle
arthritis years later.

Rheumatoid arthritis comprises about 15 per cent of ankle
arthritis. Rheumatoid arthritis is a chronic systemic autoimmune
disease that affects virtually all joints. The chronic
inflammation leads to progressive deterioration of cartilage,
bone, and ligaments.

Other types of arthritis that can attack the ankle include
psoriatic arthritis, Reiter's disease, gout, pseudogout,
sarcoidosis, juvenile arthritis, and ankylosing spondylitis.

Treatment of ankle arthritis first consists of making the
correct diagnosis. That takes a careful history and physical
examination. Laboratory testing and imaging studies such as
x-ray, ultrasound, and magnetic resonance imaging are useful.

Treatment for mild discomfort is straightforward. Limit
activities that cause pain. That means high impact sports like
running, soccer, and basketball. If excess weight is an issue,
then weight loss is mandatory. Over-the-counter
anti-inflammatory medicines can also provide symptomatic relief.

Various ankle braces can be a lifesaver. These come in
different varieties and shapes. They can fasten using laces or
Velcro. Braces may be soft or may contain a hard synthetic
shell. It is best to consult with your rheumatologist or
orthopedist before purchasing a brace.

Orthotics are shoe inserts that tilt the ankle and relieve pain
by altering the direction of stress forces. These should be
custom-made for optimal results.

Rocker bottom shoes reduce pain with walking because they limit
the amount of motion the joint has to go through. People who
have had ankle fusion surgery 9where the joijt is fused
together) often find rocker bottom shoes helpful.

When ankle pain is severe due to inflammation and/or fluid
accumulation, then aspirating the joint with a needle and
injecting a long-acting glucocorticoid ("steroid") may be very
useful. Following a procedure like this, it is a good idea for
the patient to have their ankle braced for at least three days
to rest the joint.

Physical therapy is also an excellent adjunctive therapeutic
approach. The therapist can help the patient with different
modalities that can reduce edema (soft tissue swelling0 as well
as inflammation and also teach a patient exercises to strengthen
and stabilize the ankle so that future ankle sprains and strains
are less likely.

Patients who have severe ankle arthritis due to osteoarthritis
may benefit from viscosupplementation. This is a procedure where
a lubricant is injected into the joint. Viscosupplements have
been used successfully in many joints including the knee, hip,
and shoulder, as well as the ankle.

Surgery is an option for patients who have failed more
conservative measures. Arthroscopy, which is a procedure where a
small telescope is inserted into the ankle joint through a tiny
incision. Small instruments are used to remove loose pieces of
cartilage. This procedure can also be incorporated with
simultaneous cartilage transplant where healthy cartilage is
inserted in place of damaged cartilage at the time of the
procedure. Cartilage transplant procedures are very time
intensive and require limited weight bearing for several weeks
to months afterward.

Joint realignment is a procedure where a wedge of bone is
removed from one side of the ankle so that stress forces are
transferred to the healthy part of the ankle. While this is a
temporary fix, it is useful for some patients.

Ankle fusion is a surgical procedure where the tibia (leg bone)
is screwed to the talus (upper ankle bone). This restores
alignment and reduces pain. Unfortunately, the patient loses
about half of the plantar and dorsiflexion (toe down and toe up)
movement in the ankle. The ability to walk without pain is
restored to the ankle; however, there is more stress placed on
other weight-bearing joints such as the knee, which can lead to
the development of osteoarthritis in these joints.

Ankle replacement is an increasingly popular option. In the
past, ankle replacements weren't that effective but
technological advances have improved their success. Good
candidates for ankle replacement are those who are older than 55
years of age, in good medial condition, have their weight in the
normal range, and who don't engage in high impact activities
either at work or during their leisure time.

About The Author: Nathan Wei, MD FACP FACR is a rheumatologist
and Director of the Arthritis and Osteoporosis Center of
Maryland. He is a Clinical Assistant Professor of Medicine at
the University of Maryland School of Medicine. For more info:
http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html