Ankle Arthritis

Explanation

Arthritis of the ankle can occur due to fracture, dislocation, inflammatory disease, osteoarthritis, prolonged ankle instability, repeated ankle sprains, or congenital deformity.  Patients typically present with pain that is relieved with rest, stiffness of the ankle after periods of inactivity, swelling and pain at the end of the day, and diminished or decreased motion at the ankle joint.  

Conservative treatment for ankle arthritis may include anti-inflammatory medications, use of corticosteroid injections, bracing with an ankle-foot orthosis or double-upright brace, or shoe modifications.  These shoe modifications may include a rocker bottom sole with a cushioned heel (SACH).  Bracing and shoe modifications provide support to the ankle, limiting its motion while walking and other activities.  

If conservative measures fail, surgery may be the next option.  Surgery for ankle arthritis most commonly involves either an ankle fusion or an ankle replacement.  Whether a patient gets an ankle fusion or a replacement depends upon many factors, including the patient’s age, weight, bone quality, activity requirements and associated medical conditions.  Particular considerations include a history of infection in the ankle, diabetes, and tobacco use.

Procedure

Ankle Fusion -  The remaining cartilage is removed from the ankle, and all unhealthy bone and soft tissue is removed until there is healthy, bleeding tissue on both sides of the joint.  These two ends are then held together with metal screws and/or plates while the two ends heal.  Healing time for an ankle fusion varies, but typically takes 2-4 months.  The hardware is generally permanent.

Ankle Replacement - The arthritic bone is removed from the ankle, and resection of the bone from the talus and the tibia is performed to make room for the implant.  The ankle replacement components are then placed into the talus and tibia.  Healing time for total ankle replacements can be faster than an ankle fusion, but the patient is typically in a cast for a minimum of 4 weeks.