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Printed at: 11:10:28 / 21-09-2021

Ankle Arthritis

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What is ankle arthritis?

Ankle arthritis develops when the ankle joint has damaged or worn out cartilage. The symptoms of ankle arthritis are pain, swelling and stiffness. Usually symptoms develop gradually overtime.

What causes ankle arthritis?

There are several causes of ankle arthritis. The ankle is predisposed to developing post-traumatic arthritis following an ankle fracture or severe ankle sprain. Osteoarthritis of the ankle can develop even in the absence of an injury, with no definitive cause. The ankle joint can be affected in patients with inflammatory arthritis, for example rheumatoid or psoriatic arthritis. Rarer causes of ankle arthritis include bleeding disorders such as haemophilia or a previous ankle infection.

What are the available treatments for ankle arthritis?

In the first instance simple treatment measures are recommended to try and reduce your symptoms. These can have significant benefit and help avoid having surgery. Some of the treatments for ankle arthritis are listed below, but it is not exhaustive.

Weight loss if you are overweight can be extremely effective to lessen further joint damage and reduce ankle pain.

Appropriate footwear consisting of a supportive lace up ankle boot with a cushioned sole should be tried. Alternatively, an ankle brace can be useful to support the ankle.

Physiotherapy may be beneficial in the early stages of the condition.

Simple painkillers such as paracetamol, ibuprofen or anti-inflammatory gels can reduce pain. Ask advice from your doctor or pharmacist before taking anti-inflammatory medications (NSAIDs) as they can have side-effects in some people.

Pre-scribed medications by a rheumatologist are generally required for patients with inflammatory arthritis, which can include disease modifying anti-rheumatoid drugs (DMARDs), steroids and anti-inflammatory medications (NSAIDs).

Steroid injections into the ankle joint, although are more invasive, can help reduce pain and inflammation.

Surgery for ankle arthritis is only an option as a last resort, once all simple treatment measures have been exhausted and if your symptoms remain significant. Surgical options for ankle arthritis include ankle arthroscopy, ankle fusion or ankle replacement.

Is an ankle arthroscopy beneficial for ankle arthritis?

Arthroscopic (“Keyhole”) surgery is an option to clean out the joint by removing loose cartilage, inflamed synovial tissue and bone spurs. The operation can be successful in the early stages of the ankle arthritis, when pain is due to contact between bone spurs and that has not yet caused significant joint space narrowing.

Patients can have pain relief for an unspecified period of time and their ankle stiffness improved. However, in some cases by removing the bony spurs to increase ankle movement, it causes the arthritic joint to deteriorate more rapidly.

Can I have an ankle replacement?

Some arthritic ankle joints can be treated by replacing the ankle joint, similar to a hip or knee replacement. However it is not be suitable if you are young (usually under 55 years old), you are very active or have a manual job, you have a severe foot or ankle deformity, your ankle is unstable, you are overweight or if you have had a previous infection in the ankle. Here, an ankle fusion would be advised if you wanted to proceed with definitive surgery. It is not possible to change an ankle fusion to an ankle replacement at a later date. The ankle becomes too stiff for an ankle replacement to work.

What does an ankle fusion entail?

An ankle fusion is an operation to provide a pain-free and permanently stiff ankle joint. It is a well-established surgical treatment and has been proven to be effective. The operation involves removing the damaged cartilage of the ankle joint. Then the two main bones of the ankle joint (tibia and talus) are placed in the correct position and are rigidly held together using metal screws. This allows natural bone healing to fuse your ankle joint.

Wellbeing Advice

Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.

If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.

We hope this leaflet has answered any questions you might have. If you have any further queries, please feel free to discuss them with any of the medical or nursing staff.