Ankle Pain and Arthritis

by TOI Admin December 20, 2016

By: R. James Toussaint, M.D.

When the topic of arthritis comes to mind, people usually think of the hip and knee joints. Indeed, ankle arthritis is less common than hip and knee arthritis. However, it can be just as painful and debilitating. Arthritis of the ankle is different from the hip and knee. It is usually the result of a past traumatic event such as an ankle fracture or major ankle sprain. Eventually, the damage to the joint leads to cartilage loss and progressive discomfort within the joint. In addition to pain, ankle arthritis usually results in joint swelling and stiffness. The pain may radiate up into the shin or down into the foot. 

When you come for a consultation in my clinic, it is my responsibility to you as your orthopaedic surgeon to rule out other causes of your pain. During the course of your workup, we will also obtain weight-bearing ankle X-rays to correlate with the diagnosis. Depending on the extent of the arthritis,
the images may show bone-on-bone changes.

During our appointment, my goal will be to educate you on non-operative treatment options for pain relief. The range of non-operative treatments includes activity modification (i.e., swimming instead of jogging), anti-inflammatory medications, and sturdy protective shoes. Some people may find that specific shoes, called rocker-bottom shoes, are useful because they help to propel you forward with less stress on the ankle. In many cases, an over-the-counter ankle brace is sufficient for relief. However, for severe arthritis cases, a custom brace may be needed for added stability and support. Additionally, a fluoroscopic ankle joint injection (where we use an X-ray machine to locate the joint and inject steroids directly into the joint) can be an excellent source of pain relief that can have a lasting effect. Although these non-operative options are preferred, they may not work for everyone. If your arthritis does not respond to these conservative non-surgical treatments, surgery may be an option for you. 

When is surgery the right option for you?

If you have daily pain that interferes with your quality of life and you’ve tried the above non-operative treatments, then we may consider surgery for your ankle. The type of surgery will vary depending on the extent of your arthritis. For example, early arthritis cases may be treated with a debridement, which is a type of “clean out” procedure that removes some of the inflamed tissue. End-stage arthritis will require a more extensive procedure such as an ankle fusion or a total ankle replacement. There are pros and cons to every surgery and I welcome the opportunity to discuss them in further detail with you and your family.

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