Ankle arthritis is narrowing of the ankle joint. Arthritis leads to the loss of articular cartilage, which covers the ends of the bones and allows the bones to move smoothly against each other. When the cartilage is damaged, the bones rub together during joint motion, so the patient will have pain. This can lead to pain with motion, clicking, grinding and/or a loss of strength. When arthritis becomes severe, the body attempts to stabilize the joint and limit motion by forming bone spurs or extra bone around the edges of the joint.
There are two main types of arthritis: rheumatoid and osteoarthritis. Rheumatoid arthritis occurs when the body's immune system causes inflammation in the joint. Osteoarthritis occurs when the joint surfaces wear down as a result of overuse, age or prior injury. When an infection in the joint leads to loss of cartilage, it is called septic arthritis.
People suffering from ankle arthritis may experience pain, stiffness and loss of strength. A grinding, clicking or locking sensation may be felt in the affected joint. Patients with ankle arthritis often complain of pain in the joint and difficulty walking. A limp may also be present. Loss of motion can become severe and the patient may have trouble performing daily tasks such as running or walking.
Arthritis is diagnosed by physical exam and X-ray. Your orthopedic surgeon will examine your ankle, noting range of motion, strength and pain with motion. Your surgeon may obtain additional imaging to evaluate for arthritis.
Physical therapy can assist in treating ankle arthritis to strengthen soft tissues that support the joint. The stronger the supporting soft tissues, the less the body will need to rely on bony architecture to stabilize the joint. Therapy may lead to less stress on the arthritic joint. Because arthritis involves inflammation, your surgeon may prescribe anti-inflammatory medications or recommend an injection to reduce the inflammation. For arthritis in its beginning stages, nutritional supplements may slow the progression of the arthritis.
When non-operative treatment has failed, your surgeon may suggest surgery. Numerous surgical options are available for ankle arthritis. Arthroscopy of the ankle, or an 'ankle scope', involves placing a tiny camera in the joint to assist in removing injured cartilage and bone spurs. Ankle arthroscopy is recommended only for early stage arthritis. A fusion of the ankle is used for advanced arthritis patients. A fusion eliminates movement in the ankle joint, which should decrease the patient's pain. Range of motion of the ankle, however, is strictly limited after an ankle fusion. For some patients, an ankle replacement can be substituted for fusion. This involves resurfacing the joint and replacing the injured cartilage with a smooth metal or plastic implant. This allows the ankle to move smoothly, reducing pain and in many cases, improving motion.
Osteochondritis Dissecans is a condition in which fragments of bone and cartilage become dislodged from the articular surface and form loose bodies inside the joint.
These fragments commonly originate from the talus after a high energy injury or may develop over time. Some lesions do not have an identifiable cause.
Patients will complain of painful clicking and/or locking in the ankle. Patients that have pain may also have limited ankle range of motion.
Physical exam may reveal decreased range of motion of the ankle. X-rays may help confirm the diagnosis. Fluid seen behind the fragment on MRI is an indicator of a cystic component and is a definite indication for surgical intervention because of the instability of the lesion.
Stable lesions, those not likely to displace, are treated with rest, anti-inflammatory medications and observation.
Unstable lesions, or those that have loose bodies, can be removed and microfractured arthroscopically. A microfracture plus a scaffold will be performed at the time of surgery to increase formation of normal cartilage over the area of defect. A microfracture is a standard procedure used to treat OCD lesions. The surgeon drills into the bone where the lesion is located and evens out the margins of the lesion. The drill holes allow active stem cells and growth factors to fill the lesion and direct new cells to form new articular cartilage.