October 18, 2021

Ankle injuries can lead to future arthritis pain

Sponsored Content from Cayuga Health

By Alec Macaulay, MD

Arthritis involves degeneration of the cartilage in a joint and can cause pain and stiffness in the joint. The pain is often described as an aching pain and can worsen if left untreated. Most people are familiar with arthritis that affects the back, neck, hips, knees, or hands, but may be unaware that the same degenerative disease can affect the ankles as well.

When you stand, the ankle joint supports your entire body weight. Your knee and hip joints also support your body weight, but they distribute the load over larger joint areas. Gait studies have shown that the ankle joint bears the force of up to five times your body weight when you walk. As you age, the combination of stress and the complex joint anatomy put the ankle at risk for arthritis. Almost half of people in their 60s and 70s have arthritis of the ankle, foot or both.

What causes ankle arthritis?

Ankle injuries greatly increase the risk of developing ankle arthritis, even many years after the injury. Nearly 80 percent of people with ankle arthritis report a prior ankle injury or injuries, usually an ankle fracture or bad ankle sprain(s). Ankle arthritis that develops after a significant injury is referred to as post-traumatic ankle arthritis. Some other causes of ankle arthritis are rheumatoid arthritis, psoriatic arthritis and other generalized joint diseases.

What are the symptoms of ankle arthritis?

Many patients have pain or stiffness at the ankle, oftentimes making it difficult to walk. The pain may be periodic, sometimes occurring after activities such as jogging that add stress to the ankle joint. Other symptoms may include joint swelling and tenderness when pressure is applied to the joint.

How is ankle arthritis treated?

There is no cure for arthritis, but there are treatments that relieve the pain and disability it can cause. Early treatment of ankle arthritis is usually nonsurgical. If these nonsurgical measures do not provide enough pain relief then surgery may be an option.

What are the non-surgical treatments?

Switching from high-impact activities like jogging to lower impact activities like swimming can minimize the stress on your ankle and reduce pain. Weight loss also reduces stress on the joints, lessening pain and increasing function.

Physical therapy may help increase the joint’s range of motion and flexibility, strengthen muscles and reduce pain. Canes, fitted ankle braces and special shoes can all minimize pressure on the ankle and decrease pain. Nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, can help reduce swelling and relieve pain. Cortisone injections can provide pain relief and reduce inflammation, but the effects are usually temporary.

Again, these treatments do not “cure” the arthritis, but can make the symptoms more tolerable.

What are the surgical treatments?

When nonsurgical treatments do not provide sufficient relief, surgery may be an option.

In the early stages of ankle arthritis, arthroscopic surgery may be used to remove loose cartilage, inflamed tissue and bone spurs from around the joint. In this procedure, a tiny camera is inserted through an incision at the ankle. The camera allows the surgeon to guide miniature surgical instruments to the surgical site. Arthroscopic surgery is most effective when the pain is due to contact between bone spurs. Removing the spurs can reduce pain and allow for more flexibility in the joint.

Another procedure, called an ankle arthrodesis or ankle fusion, fuses the bones of the ankle joint together and reduces pain by removing the arthritic joint altogether. The joint is fixed in a permanent position with screws or plates. Over time, the bones heal together, eliminating the joint and the pain.

An alternative surgical option to an ankle fusion is a total ankle replacement. An ankle replacement involves removing the arthritic joint and replacing it with a metal and plastic prosthetic joint. This is similar to hip and knee replacements. The innovative treatment called ankle arthroplasty is performed at Cayuga Medical Center and a future Health Watch will examine that procedure in more detail.

Dr. Alec Macaulay is an orthopedic surgeon with Cayuga Orthopedics and serves on the medical staffs of Cayuga Medical Center and Schuyler Hospital. His clinical interests include both the surgical and non-surgical treatment of athletic injuries, arthritic conditions and musculoskeletal trauma. He specializes in surgery of the knee, ankle and foot and can be reached at (607) 272-7000.