ARTHRITIS OF ANKLE
I have been advising my patients to exercise, keep active, and walk as long as they can in order to stay mobile and healthy. However, seniors and others suffering from repeated trauma such as fractures and sprains, often tell me activities that require prolonged walking is limited by ankle pain from arthritis. They often ask, “What is arthritis of the ankle?” How does it happen? What can I do about it?
Gerry Davis, assistant baseball coach at Lackawanna College, is a typical example of the ankle arthritis journey. He has suffered for many years from ankle arthritis and pain. He sustained repeated injuries as a young athlete and, when conservative treatment was no longer effective and he was no longer able to walk without a painful limp, he had an ankle replacement.
Three Most Common Forms of Arthritis of the Ankle
- Osteoarthritis – is also known as degenerative arthritis. It is the most common form of arthritis in the ankle. It is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the ankle joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle.
- Rheumatoid Arthritis – is a form of inflammatory arthritis in which many joints of the body can be affected. It is very destructive to the cartilage, joint and tissues surrounding the joint. It can occur at any age and usually affects multiple joints.
- Post-Traumatic Arthritis- is a form of arthritis that can occur following a trauma or injury to the ankle. It is a form of osteoarthritis that is triggered years after a fracture or ligament injury. Jim Gouldsbury, Jr., a local letter carrier for the United States Postal Service, knows the effects of prolonged weight-bearing with on an injured leg. Jim suffered from an ankle injury several years ago and workes in a job that requires constant weight-bearing. He is now suffering from traumatic arthritis at a relatively young age.
Symptoms of Arthritis
- Pain - usually occurs gradually. However, a sudden onset can occur, especially associated with a sudden twist or fall. Pain is often worse in the morning and improves with movement. Changes in the weather or barometric pressure can cause pain associated with arthritis.
- Swelling – can swell after increased activity at the end of the day.
- Stiffness – is more noticeable in the morning and improves with movement. However, overuse can create more pain and swelling and lead to stiffness also.
- Weakness – from disuse associated with pain and can lead to occasional buckling of the ankle when walking or climbing steps.
- Loss of Function- is associated with pain, swelling, weakness and stiffness which limits walking, stair climbing etc.
Diagnosis
Your family physician will examine your ankle to determine if you have arthritis. In more advanced cases you may be referred to a specialist such as a podiatrist, orthopedic surgeon or rheumatologist for further examination and treatment. X-rays will show if the joint space between the bones in the ankle is getting narrow from wear and tear arthritis. If rheumatoid arthritis (RA) is suspected, blood tests and an MRI may be ordered. The diagnosis will determine if your problem is minor, moderate or severe.
Treatment
Conservative Treatment
In the early stages your treatment will be a conservative, nonsurgical approach, which may include; anti-inflammatory medication, orthopedic physical therapy, exercise, activity modifications, supplements, bracing, etc. You and your family physician, podiatrist, orthopedic surgeon or rheumatologist will decide which choices are best.
- Anti-inflammatory Medications: such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling in the joint.
- Orthopedic Physical Therapy: such as heat, cold, ultrasound, electrical stimulation, joint mobilization, range of motion exercises, strengthening exercises, partial weight bearing aerobic exercises.
- Activity Modifications: such as eat well and lose weight, doubles tennis instead of singles, sitting or lying leg exercises instead of standing, walk instead of run, soft bed treadmill instead of hard surfaces, avoid squatting, kneeling, and bending.
- Supportive Devices: such as ankle sleeves, light bracing, orthothics (inserts), use good running shoes for exercise and walking, use good quality supportive shoes for work/dress.
Conservative But More Aggressive Treatment
- Corticosteroids: stronger anti-inflammatory medications than those above which are injected directly into the ankle joint.
- Viscosupplementation: a type of synthetic fluid, injected into the ankle joint and designed to imitate the joint fluid of the ankle to promote healing and mobility.
- Glucosamine and Chondroitin: supplements taken orally to control the pain of osteoarthritis and promote healing.
- Rheumatoid Medications: specifically designed for RA (anti-inflammatory or biologic drugs)
- Surgical TreatmentWhen conservative measures are no longer effective in controlling pain and deformity and fail to improve strength and function, then more aggressive treatment may be necessary.
- Arthroscopic Surgery: uses a scope to clean and repair damaged tissues inside the ankle joint.
- Fusion Surgery: the ankle bones are surgically fused together to limit movement of a painful joint.
- Total Ankle Replacement: replaces severely damaged joint surfaces with metal and/or plastic.SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.
