Ankle > Arthritis

What is Ankle Arthritis?

Arthritis is a degenerative disease that results from destruction of the cartilage in your ankle. Where your shinbone (tibia) and anklebone (talus) meet, the bone surfaces that rub together are covered by cartilage. It is normally very smooth and lubricated with joint fluid that allows nearly frictionless motion of the joint. When arthritis affects a small area of joint cartilage, it loses its smooth glistening surface and becomes rough and irregular. The result is further destruction of the rest of the joint as the imperfect surfaces contact one another. To limit motion in an arthritic joint, your body may attempt to create new bone surrounding the joint as a response to the destruction. But these painful bone spurs in the front of your ankle cause a condition called anterior impingement syndrome, which can be a sign of ankle arthritis. Eventually, pieces of cartilage can break off and float in the joint fluid, causing further destruction to the once-smooth surfaces. The end result is partial or complete destruction of the joint and, finally, deformity.

The most common form of arthritis is called osteoarthritis. The wear and tear of sports and activities may put active people at risk for osteoarthritis, but it can also be a hereditary condition. Other types of arthritis are forms of systemic inflammatory diseases that are not necessarily related to sports or activities, as there may be genetic causes for the development of this type of arthritis. The most common of these is rheumatoid arthritis, which is thought to be a result of the body’s immune system attacking body tissues such as cartilage. This discussion addresses osteoarthritis in the ankle.

Osteoarthritis may begin after repeated minor injuries to your ankle or a specific traumatic injury - especially a fracture. Overuse and years of chronic stress on your ankle may also cause arthritic deterioration. Though physicians are not exactly sure what causes osteoarthritis, many contributing factors have been identified that put people at risk.

   Age – The majority of people who suffer from arthritis are over the age of 45. By age 60, most people have some signs of mild osteoarthritis. However, athletes and active people may be at risk of developing osteoarthritis at a younger age because of the added stress that activities place on their joints.

   Genetics – Some people who suffer osteoarthritis may have inherited a propensity to develop the disease.

   Weight – Extra pounds put added stress on your ankles. Controlling your weight can help relieve some of the pain associated with arthritis.

   Activities – Overuse is the most common activity associated with osteoarthritis, as it contributes to wear-and-tear and can erode ankle cartilage.

   Abnormal body structure – Joints that are not aligned properly or not matched in size, length, or strength may cause slight imbalances that put added stress on your ankles and may cause premature arthritis.

p;nav=Pat" target="_new">Melvin R. Manning, M.D., team physician for the Dallas Burn.

Ankle osteoarthritis generally continues to progress unless it is treated. Though there is no cure for arthritis, most people can slow the progression of the disease if they seek early treatment. Treatment is necessary because your cartilage has no direct blood supply and usually cannot heal on its own. In addition, cartilage cannot regenerate. Younger people have a better ability to heal small areas of damaged cartilage without undergoing surgery. Active people over 40 are more likely to develop osteoarthritis as a complication of an injury. However, arthritis can occur after a significant injury at any age. Most patients are treated conservatively because surgery to treat ankle arthritis is usually a major operation. The initial symptoms often can be treated with rest, shoe modifications, bracing, and anti-inflammatory medications. Most younger people with signs of early arthritis can return to some type of activity after non-operative treatment. As the disease progresses, surgery, which may be fusion of the your ankle joint or a total ankle replacement, may ultimately be required. Surgery is primarily prescribed for older patients who have been unable to walk more than a few blocks for months or years. After ankle fusion surgery and total ankle replacement, pain typically goes away and you can get around again, but you usually can no longer participate in most sports activities that involve bearing weight on your ankle. The links to the left explain standard ankle osteoarthritis treatments in detail.p;nav=Pat" target="_new">Melvin R. Manning, M.D., team physician for the Dallas Burn.

Orthopedic Evaluation

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

Your physician will likely ask you when you noticed your ankle pain, how it has been feeling since the pain began, and if your ankle was injured previously. You should reveal any relevant ankle surgery history at this time. Arthritis is suspected when you have a history of chronic swelling in your ankle, pain with walking a certain number of blocks, and limited activity participation because of your ankle pain. Physicians also typically ask about other conditions, such as personal habits, other medical conditions like diabetes and allergies, and medications currently being taken. You may also be asked about your physical and athletic habits and goals – information that will help decide what treatment might be best for you in achieving your goals.

PHYSICAL EXAM

Your physician typically presses areas all around your ankle to see where your joint is tender. Your ankle is moved in all directions to test the joint’s range of motion. When your physician moves your foot up and down and compares it to the other side, your arthritic ankle often cannot move as far.

X-rays of your ankle usually are taken while you are standing up, so that your physician can see your ankle as it bears your body weight. X-rays usually can reveal arthritic degeneration, and may show narrowing of the ankle joint space between the shinbone and talus, deformity, loose bone fragments, bone cysts, or other types of bone damage. Most patients with osteoarthritis will only require an X-ray unless the diagnosis is in doubt.p;nav=Pat" target="_new">Melvin R. Manning, M.D., team physician for the Dallas Burn.