Ankle Arthritis Treatment Guide

What is Ankle Arthritis and How is it Treated?

Arthritis, which essentially means damage to a joint, can occur anywhere in the human body. Because the ankle is a commonly injured joint, wear and tear that slowly occurs over the years after an injury may cause problems later in life. This post-injury degeneration is one of the reasons that it is critical that you seek appropriate treatment for ankle sprain or another ankle injury when it happens.

If you have ankle pain of any kind, make an appointment today to see us in our Seattle clinic.

Video: Ankle Arthritis Treatment Options

“Degenerative arthritis” is damage to and inflammation of a joint due to wear and tear and is called osteoarthritis. In general, the term arthritis describes more than 100 different ailments including inflammatory conditions, such as gout, infection, and rheumatoid arthritis. Each has its cause and treatment protocols.

At the Foot and Ankle Center of Washington, we can treat most cases of ankle arthritis in a conservative manner and avoid surgery. Because ankle arthritis can worsen over time, you should be seen as soon as possible if you are experiencing symptoms of arthritis or ankle pain or if you have been diagnosed with arthritis of the ankle. Contact us today for an urgent appointment about your ankle pain.

Below are answers to the most frequently asked questions we get about ankle arthritis.

• Who Gets Arthritis of the Ankle?
• What Are the Symptoms of Ankle Arthritis?
• How Is Ankle Arthritis Diagnosed?
• How Is Ankle Arthritis Treated?
• What Non-Invasive Methods Treat Ankle Arthritis?
• When Is Surgery Recommended for Ankle Arthritis?
• Which Surgical Option Is Better for Ankle Arthritis?
• Talar Dome Lesions

Who Gets Arthritis of the Ankle?

Roughly 90% of those with ankle arthritis either have a medical condition that makes them prone to osteoarthritis or have suffered prior trauma to their ankle joint. In recent years, evidence increasingly indicates that osteoarthritis may be genetic and has a tendency to occur in families. Research also suggests that osteoarthritis without a prior injury may be related to the chemical make-up of the cartilage in the joint.

A joint that was previously injured is seven times more likely to develop arthritis and injury is the underlying cause in as many as 80% of ankle arthritis cases. Other causes of osteoarthritis of the ankle include underlying medical conditions like:

• Rheumatoid arthritis
• Hemophilia or hemochromatosis
• Clubfoot or genetic defects that impact ankle alignment
• Circulation disorders including avascular talus necrosis and osteochondrosis dissecans

What Are the Symptoms of Ankle Arthritis?

When the ankle joint is severely damaged, cartilage often rips from the bone. The fragments of cartilage then float within the joint causing pain and further damage. Because cartilage does not heal or grow back, this causes a permanent defect that will fill with scar tissue over time, causing more pain and instability. Ultimately, the joint will no longer function, resulting in increased inflammation and severe joint pain.

When asked if ankle pain limits their activities, most patients may not be aware that it does. But when we ask how their activity level compares now with five years ago, many see they have modified their activities because of ankle discomfort. Contact us for an immediate appointment at our Seattle offices if you’re experiencing these symptoms:

• Chronic or recurring ankle pain
• Ankle pain after sitting or sleeping
• Swelling in the ankle
• Ankle stiffness
• Lessened range of motion in the ankle
• Popping or other sounds when flexing or pointing toes

How Is Ankle Arthritis Diagnosed?

When you come to see us at the Foot and Ankle Center, we will review your medical records and family history to consider risk factors to help determine the type of arthritis you may have. A thorough physical examination helps evaluate and determine the type and extent of damage to the joint. During this exam, we will measure your ankle’s range of motion and may draw fluid to check for an infection. We will also take x-rays to assess the extent of damage and help guide the diagnosis.

How Is Ankle Arthritis Treated?

There are a number of conservative, non-surgical ankle arthritis treatment protocols available which have proven to be highly effective. It is our goal to avoid surgery if at all possible. In fact, the mildest forms of ankle arthritis may be treated by avoiding high impact activity and making better shoe choices. We always try non-surgical treatments for ankle arthritis first and have a good track record of eliminating or greatly reducing pain without surgery. And if your ankle arthritis does not respond to more conservative therapies, we will let you know if and when surgery should be considered.

What Non-Invasive Methods Treat Ankle Arthritis?

Avoiding impact activities such as jumping and running and switching to swimming, cycling, or walking on cushioned surfaces may help significantly. Beyond basic activity changes, below are some conservative measures we may recommend when treating your ankle arthritis:

• Foot Orthotics for Ankle Arthritis – When ankle arthritis is severe, custom foot orthotics that protect the ankle joint may be recommended. A custom orthotic made to conform to your feet can greatly reduce ankle pain. Specialized orthotics with features designed to offer greater control are preferable as standard orthotic devices usually won’t offer optimum pain relief.
  

  FootChair Adjustable Arch Orthotic

  However, if you are not able to obtain a custom orthotic we suggest the FootChair Podiatrist Designed Adjustable Arch Orthotic. This has the best arch height we have found on an over-the-counter arch support due to an adjustable arch via pads that can be inserted under the cover.

• Ankle-Foot Orthotics (AFOs) for Ankle Arthritis – For patients with stiff and painful joints, bracing may be a helpful treatment. Bracing may
  

  Aircast Airlift Brace

  be as simple as one used for an ankle sprain. These can alleviate your symptoms at a minimal cost. Our favorite OTC brace for ankle arthritis is the Aircast Airlift.

If a prefabricated ankle brace isn’t effective, a custom ankle-foot orthosis (“AFO”) is the next step and is a custom brace fashioned from a cast of your foot and ankle. A “gauntle AFO” is usually the most effective AFO for ankle arthriti. Our doctors are experts at fabricating AFOs that are comfortable and effective. If you wore an AFO in the past and had trouble with it, be aware that today’s AFOs are much sleeker and more comfortable than those of even a few years ago.

• Shoe Modifications for Ankle Arthritis – In addition to foot or ankle-foot orthotics, shoe modifications can help reduce stress on the ankle joint. In particular, a modification called a “rocker sole” has been shown in studies to significantly reduce stress on the ankle. We can advise you if a rocker sole is a good option for your condition. If it is, we can prescribe a rocker sole to addition to your shoes. Rocker soles can be added to many different types of shoes.

• Medications for Ankle Arthritis – We may also recommend medication such as non-steroidal anti-inflammatories (NSAIDs) or medications prescribed by a rheumatologist if you have autoimmune or inflammatory medical conditions contributing to your ankle arthritis. There are many types of medications that can be part of a first line of defense against arthritis prior to considering any surgical procedure.

• Supplements for Ankle Arthritis – Many patients ask about supplements such as glucosamine and chondroitin for arthritis treatments because they have seen advertisements promising relief. However, there is no evidence that they are effective and significant evidence that they do not work. The largest and best-designed study to date is the Glucosamine-Chondroitin Arthritis Intervention Trial (GAIT) supported by the National Institutes of Health. The GAIT study showed that Glucosamine-Chondroitin did not reduce osteoarthritis pain more effectively than a placebo. Those on standard anti-inflammatory medicines did about 17% better than a placebo. Thus, this is not a recommended therapy for ankle arthritis.

When Is Surgery Recommended for Ankle Arthritis?

If the less invasive measures do not effectively address ankle arthritis symptoms, you continue to experience significant pain and are suffering disability, surgery may be recommended. At the Foot and Ankle Center, our expert podiatrists are often able to achieve meaningful pain relief without resorting to surgery. If you have been told by another doctor that you need ankle surgery, we encourage you to contact us for a second opinion.

Which Surgical Option Is Better for Ankle Arthritis?

Once less invasive methods are exhausted and if relief has not been achieved, one of three surgical options may be recommended. These include Osteomoty (rarely used), Ankle Join Fusion or Ankle Joint Replacement. We will recommend a surgical protocol based on your unique circumstances, extent of your pain, your specific diagnosis and cause of your ankle arthritis. Here’s a look at the three surgical procedures – only two of which are commonly recommended:

• Osteotomy – If the joint destruction is asymmetric (only on one side of the joint), then the physician may consider an osteotomy. This involves cutting the bone to change the weight-bearing surface of the joint and help distribute the weight more evenly. This is usually not successfully performed in the ankle, however, in rare cases, it is sometimes considered.

• Ankle Joint Fusion – Also called arthrodesis, this procedure permanently stiffens the ankle using screws that are permanently affixed to the bone. Up until recently, ankle fusion was the traditional surgical option for ankle arthritis because of its pain relieving ability. However, the fusion results in severely limited motion. Over time, the joints above and below the fusion (the foot and knee) take on extra stress.

Until roughly five years ago, there did not appear to be any decent ankle replacement components that demonstrated positive long-term results. While ankle fusion is still a successful option for relieving the pain of the disease within the joint, a new generation of implant designs and surgical techniques have provided patients with an additional viable option for treatment.

• Ankle Joint Replacement – Replacement of the ankle with artificial parts is called prostheses and can help those that suffer severe arthritis of the ankle. According to the American College of Foot and Ankle Surgeons (ACFAS), total ankle replacement surgery is a safe and effective treatment option for select patients with end-stage ankle arthritis, a leading cause of chronic disability in North America.

Studies have shown that total ankle replacement surgery where the ankle joint is replaced with an artificial joint can improve patient function, reduce pain, and improve the quality of life for patients. ACFAS surgeons note that not every patient with severe arthritic disease of the ankle is a candidate for total ankle replacement surgery.

Talar Dome Lesions – Osteochondral Defects of the Talus

A talar dome lesion is type of very localized arthritis of the ankle and is essentially a divot in the cartilage and bone on the top of the talus bone of the ankle. It is also known as an osteochondral lesion of the talus.

Talar dome lesions are usually caused by an injury. For example, in a situation where an ankle sprain is just not healing the way that it should one of the diagnoses we will always consider would be a talar dome lesion. In many cases the pain associated with osteochonral defects of the talus can take months or even years to show up after the precipitating injury.

Signs and Symptoms of Talar Dome Lesions Include:

• Pain deep within the ankle joint
• Pain that is worse with activity (they often hurt during sports activities)
• Occasional clicking or “catching” of the ankle during walking
• A feeling that the ankle is “locking up” or “giving out”
• Occasional swelling of the ankle

Diagnosis of Talar Dome Lesions

These injuries can sometimes be difficult to diagnose as the symptoms are often very intermittent. Many times a diagnosis is based primarily on a patient’s history. In our examination we will look for any clicking or catching of the ankle, although those signs are not always present.

X-rays are usually taken, but in general these osteochondral ankle lesions are difficult to see on x-ray. We may sometimes inject the ankle with a local anesthetic to determine if that eliminates the pain. If so that is a strong sign that the pain is limited to the ankle joint.

In most cases we will get a bone scan and an MRI to determine the definitive diagnosis.

Treatment of Osteochondral Lesions of the Ankle

We will usually try to treat talar dome lesions with non-surgical treatment. Non-surgical options include:

• Foot orthotics to provide better alignment of the ankle
• A period of immobilization in a walking boot to let the ankle tissue rest and heal
• Use of an ankle brace to protect the ankle while letting the patient get back to activity
• Physical therapy to strengthen the ankle

Surgery is considered if non-surgical treatment fails to relieve the pain. Surgery often involves removing the loose bone and cartilage from the joint. Sometimes this can be done via arthroscopic surgery but there are a number of surgical approaches to this condition each with their own advantages and disadvantages. We will discuss each approach with you.

Contact Us Today for Ankle Arthritis Treatment in Seattle

Dr. Douglas S. Hale and Dr. Lawrence Z. Huppin of the Foot and Ankle Center of Washington are skilled specialists with advanced training in foot and ankle conditions. Both have decades of experience and are well known for their conservative, non-invasive, yet highly effective treatment of your ankle arthritis. Our doctors have earned the trust of hundreds of referring physicians, as well as thousands of satisfied patients.

Don’t live with ankle pain. If you live in the Seattle / Puget Sound area and would like to have your ankle pain treated in the most effective and conservative method possible, contact us for an appointment in our Seattle office. If you are coming in from out-of-town for ankle pain evaluation and treatment, be sure to let our receptionist know when you make your appointment.

A list of articles from the medical literature related to the use of orthotics in treating ankle arthritis is available on our bibliography page.