Ankle Arthritis
Background
Arthritis is the loss of cartilage in a joint. Ankle arthritis develops from aging, overuse, ankle sprains, neuropathy, or old trauma. Without the cartilage, you have “bone on bone” contact, which creates pain and stiffness. This creates problems with walking, exercising, standing, working, and carrying out the everyday tasks of life. Ankle arthritis is typically progressive, getting worse over time. It is debilitating, and it deserves to be treated.
Fortunately, there are very good treatments for ankle arthritis. Dr. Bohl believes that every patient should attempt nonsurgical treatment prior to surgery, and he has a well-developed protocol to help you with this. If nonsurgical treatment is insufficient and/or you would like to consider surgery, Dr. Bohl will likely order a CT or MRI to better understand your specific form of arthritis.
Which solution is best for you depends on a number of factors including the type of arthritis, associated deformity, condition of the surrounding joints, appearance on CT or MRI, your activity level, and your goals and priorities.
Dr. Bohl believes it is his job to educate you and to present you with all possible options for treatment. Ultimately, of course, the choice is entirely yours.
Nonsurgical treatment
Nonsurgical treatment of ankle arthritis can be effective. All patients should try nonoperative treatment first. Options include the following:
Anti-inflammatory medications (both topical and oral)
Bracing and orthotics
Ankle injections (steroid, viscosupplementation, PRP)
Focused home exercise and physical therapy
Ankle scope
Early ankle arthritis on MRI
For patients with early, mild, or regional arthritis, an ankle scope (aka arthroscopy) may be the best first step. An MRI is usually obtained to guide treatment.
In this minimally-invasive procedure, two tiny poke-hole incisions are made on the front of the ankle. A camera is inserted through one of the incisions, while a shaver is inserted through the other. Using the camera and shaver, diseased cartilage and inflammatory tissue are removed to relieve pain. Small holes may be created in the bone to release your body’s natural regenerative cells and facilitate formation of new cartilage. Extra bumps of bone that block motion (osteophytes) may be removed from the front of the ankle to increase motion. Any loose pieces of bone, cartilage, or other floating debris are removed from the joint space.
After surgery, you are allowed to walk immediately. Physical therapy is encouraged to maintain motion and increase strength.
Ankle replacement
For patients with severe arthritis, an ankle replacement may be the best solution. In an ankle replacement, the diseased cartilage surfaces of the joints are removed and resurfaced with metal and plastic. Specifically, metal components are attached directly to the bony surface, and a plastic bearing (gliding surface) is placed in between the metal components. Because the diseased cartilage and bone are removed, and because you no longer have “bone-on-bone” contact, the pain is relieved.
Ankle replacement technology has evolved markedly over the last 15 years. When properly placed, these implants are now very durable. The advantage of ankle replacement over ankle fusion is maintenance of motion at the ankle joint. By maintaining this motion, stress is relieved from the rest of your foot and lower extremity, and your gait remains more natural.
Not everyone is a candidate for ankle replacement, as some people’s age, activity level, neurologic status, and/or medical conditions may increase the chance for failure. Dr. Bohl will be happy to discuss the relative advantages and disadvantages of ankle replacement with you in the clinic.
After an ankle replacement, patients are typically in a cast for 6 weeks and then a boot for 4 weeks. We recommend a knee scooter to help you get around during this period. Physical therapy is an important part of the postoperative protocol.
Ankle fusion
For other patients with severe arthritis, an ankle fusion may be the best solution. An ankle fusion is a remarkably functional and durable solution. Patients with ankle fusions are allowed to run, hike, play tennis, play golf, play basketball, and do any other activity they desire without limitations.
In most people with severe ankle arthritis, the ankle joint isn’t moving much anyway (the arthritis has made it very stiff). Often there will be the appearance of some motion, but this is usually coming from the other joints near the ankle, not from the ankle itself. An ankle fusion turns the ankle from a “stiff and painful” joint into a “stiff and painless” joint. Rates of patient satisfaction are extremely high.
After an ankle fusion, patients are typically in a cast for 6 weeks and then a boot for 4 weeks. We recommend a knee scooter to help you get around during this period. Physical therapy is not necessary.