Ankle arthritis is loss of the ankle joint cartilage lining and usually occurs over a period of years. The most common cause is a previous injury, but in some patients, it may occur as part of a more widespread process such as rheumatoid arthritis, haemophilia, or gout.

Symptons

Regardless of the cause, the effect is similar. There is a narrowing of the ankle joint space between the tibia (shin bone) and the talus (ankle bone) and bony spurs (osteophytes) develop. The ankle becomes painful, often stiff, and may ‘grind’ or lock up due to lose fragments of bone. Even though ankle arthritis is far less prevalent than arthritis affecting joints such as the knee and hip, it can be equally, or even more debilitating and painful.

Treatment – Non-operative

Early or mild ankle arthritis is treated with simple measures such as activity and lifestyle modification. These include losing weight, using walking aids such as a walking stick, and avoiding impact activities such as jumping and running. Low impact activities such as cycling, swimming, and walking are recommended.

When arthritis becomes more severe, the next step is painkillers and anti-inflammatory medications (if tolerated). These may be used in combination with physiotherapy, orthotics (shoe inserts), shoe modifications (rocker-bottom sole), or an ankle brace. Sometimes injections of cortisone may offer temporary relief however as with all treatments, the degree and extent of relief varies from patient to patient.

Walking Aid

A walking aid can help increase mobility when difficulty moving is experienced.

Medication

Painkillers and anti-inflammatory medication such as tablets and creams can be prescribed by your doctor to assist in reducing pain.

Physiotherapy

Physiotherapy is useful to regain range of movement, strength, balance and joint position sense.

Footwear and Orthotics

Wearing appropriate footwear and orthotics (stiff insoles or shoes with a rocker-bottom sole) can be helpful.

Ankle Brace

An ankle brace for greater support may be useful for people who have tried all the above measures and experience ongoing problems with daily or sporting activities.

Cortisone Injection

A corticosteroid injection may offer relief from ankle pain and help settle symptoms.

Treatment – Surgery + Risks and Complications

When all the previous measures fail, there are 3 main surgical options. These are arthroscopic debridement, joint arthrodesis (fusion), and joint replacement. The best option for an individual patient depends upon many factors including the severity of arthritis, the age and functional demands of the patient, and the presence of arthritis in other joints. The ultimate choice is a combined decision between surgeon and patient.

Arthroscopic Debridement

This is a day case procedure with a relatively rapid recovery (4-6 weeks). A small camera and surgical instruments are inserted through keyhole incisions. It is generally most suitable for early arthritis. Bone spurs and loose bodies can be removed, and irregularities in remaining cartilage may be tidied up. However, as the underlying arthritic process is still present the response to surgery is variable. Around 70% will experience an improvement in symptoms and 2-5% may deteriorate and require further surgery sooner than initially expected. The duration of symptomatic improvement is unpredictable.

Ankle Arthrodesis

This has been the “gold standard” treatment for severe arthritis. The surgical technique involves removing bone from the tibia and talus joining them with screws. Eventually, the ends of the bones grow or fuse together. Even though ankle motion is eliminated, adjacent joints compensate and may allow up to 50% of this motion to return. However, the increased load across these other joints can cause arthritis to develop and some patients will require fusion of other joints at some stage in the future.

In the past, this procedure was performed through large incisions that resulted in long recovery times. In most cases now, this can be undertaken through 2 or 3 small incisions around the ankle. This results in less pain and a more rapid recovery. The main role of fusion is in younger patients with higher physical demands and in whom the ankle is the only affected joint. In these circumstances, a successful fusion is very reliable in providing long-term pain relief that results in a limp free gait and allows return to more physical work.

Potential risks and complications will be discussed with you, but in general 90% of patients are satisfied. 2- 5 % of patients will require further surgery due to failure of the bones to fuse, while 10% may require surgery elsewhere in the foot for arthritis.

Total Ankle Replacement

This replaces the inside of the ankle joint and requires functioning ligaments on the outside. One metal component is fixed to the tibia and the other to the talus. The third component is a polyethylene (dense plastic) bearing which sits between the other two. When compared with an ankle fusion, it provides a similar level of pain relief but the main advantage is that it preserves some of the pre-operative motion of the ankle. As a result, it reduces the subsequent stresses upon the knee and other joints in the foot. It is best suited for patients over 65 years of age with lower demands (not heavy physical work) and a well-aligned ankle.

The main disadvantage is that it contains moving parts that can wear out. This occurs in roughly 2-3% of patients per year and when it occurs, usually requires conversion to an ankle fusion, which can take a long time to knit together successfully. The potential complications will be discussed with you, however in general 95% of patients are very satisfied with the result. Occasionally the procedure may fail early requiring fusion, and 2-10% require maintenance surgery in the first 5 years. After 5 years, the failure rate is 1 to 2% per year for all causes and so roughly 80 to 85% are still functioning well after 10 to 15 years.

RECOVERY TIMES (Arthrodesis)

Hospital stay 2 nights
Rest and elevation 10-14 days
Half-cast/Backslab (non-weight bearing) 2 weeks
Full cast (non-weight bearing) 6 weeks
Camwalker boot (full weight bearing) 4 weeks
Walking aid (crutches/knee scooter) 8 weeks
Time off work
– Seated
– Standing
3-4 weeks
3 months
Walking well 4-5 months
Swelling settles 6 months
Final result 12 months

RECOVERY TIMES (Replacement)

Hospital stay 2 nights
Rest and elevation 10-14 days
Camwalker boot (full weight bearing) 8 weeks
Walking aid (stick/frame) 1-2 weeks
Time off work
– Seated
– Standing
2-3 weeks
8-10 weeks
Walking well 3 months
Swelling settles 6 months
Final result 9-12 months

Contact

This fact sheet is a brief overview of ankle arthritis, produced by our Foot and Ankle Surgeon Dr James Clayton. To make an appointment or enquiry with Dr Clayton or a member of our foot and ankle team, contact 08 8362 7788 or email ortho@sportsmed.com.au.

Foot and Ankle Team