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What Is Ankle Osteoarthritis?

According to the CDC, osteoarthritis is the most common form of arthritis. We spoke with an HOI foot and ankle orthopedic surgeon to get his expertise on ankle osteoarthritis.

Q: What causes ankle osteoarthritis?

A: The incidence of ankle arthritis is much lower than that of hip and knee arthritis. The vast majority of ankle arthritis is related to a trauma or injury; such as having had an ankle fracture or severe ankle sprain that resulted in ankle instability. These injuries can cause damage to the cartilage of the ankle at the time of injury, changes in kinematics of the joint, or even cause a deformity that results in arthritis. Another cause of ankle arthritis can be from underlying foot deformity such as a severe flat-foot or high arched deformity. Other causes include inflammatory diseases such as rheumatoid arthritis; diseases such as hemophilia which can cause bleeding into the joint, and primary osteoarthritis (arthritis of old age) which only accounts for approximately 10% of ankle arthritis.

Q: Typically, how long does it take to reach end-stage ankle arthritis after diagnosis of arthritis?

A: This is very dependent and can vary drastically in each patient. Certain types of fractures such as pilon ankle fractures have very high rates of early development of severe post-traumatic arthritis; whereas there are patients who develop mild arthritis and do not go on to developing bone-on-bone or end-stage arthritis.

Q: What are the symptoms of end-stage ankle osteoarthritis?'

A: Significant pain, swelling, and stiffness in the ankle. It is important to differentiate ankle arthritis from subtalar arthritis (the joint below the ankle which controls side-to-side movement of the hindfoot). Sometimes patients can feel crunching, catching, or locking of their ankle joint. Difficulty walking long distances, up and down hills, and uneven surfaces is a frequent symptom. Loss of range of motion is also a very common finding.

Q: What would be some considerations when deciding between ankle replacement or fusion?

A: Patient factors are a major consideration when deciding between replacement and fusion. Typically, a fusion is undergone on younger patients, as the lifespan for an ankle replacement is usually around 15 years and the replacement is not meant for any high impact activities. If there is underlying arthritis in other joints in the foot, sometimes this favors an ankle replacement as the other joints in the foot only have fusion as a surgical treatment option and undergoing an ankle fusion with other options in the foot can significantly impact gait mechanics. Other considerations include deformity of the ankle joint as this may favor the choice of fusion. Historically, very stiff ankles with significant loss of range of motion was a consideration for fusion as most patients do not gain any motion from ankle replacement; however, there has been newer literature suggesting this should not necessarily be a major factor in surgical decision making as very stiff patients still had very good outcomes from ankle replacement. Overall, both are very good surgical options and shared decision making should be undergone when discussing these options with your surgeon to find which surgery will be optimal for your specific pattern of arthritis as well as your specific needs as a patient.

Q: If you have ankle osteoarthritis, what steps can you take to preserve your joints for as long as possible?

A: Maintaining your motion by doing daily range of motion and stretching exercises. Wearing stiff, supportive, and well cushioned shoes. Finding activities that keep you active and do not aggravate or exacerbate your ankle arthritis, such as biking or swimming. Maintaining a healthy body weight as higher body weight places significantly more forces through the ankle. Wearing an appropriate brace and rocker-bottom shoes during high impact activities, when walking on uneven surfaces, or when walking for long distances.

Q: Anything else we should know?

A: Ankle arthritis can be significantly debilitating; however, it is important to exhaust all conservative managements prior to considering a surgical option for treatment as surgery carries significant risks. The conservative managements typically utilized include NSAIDs, weight loss, physical therapy, ankle braces, shoe type and activity modifications, the use of a cane or walker, and corticosteroid injections. If the pain and symptoms from the arthritis are significantly affecting a patient's activities of daily living and are unable to be alleviated with conservative treatments then surgical options can be considered. Total ankle replacement as well as ankle fusion are the most common surgical treatments for ankle arthritis; however, there are rare occasions when other surgeries should be considered such as supramalleolar osteotomy or arthroscopic ankle debridment, but these are not necessarily appropriate for end-stage ankle arthritis.