The ankle joint can be described as a nearly perfect joint. If nothing goes wrong, if you have no ankle trauma, you are very likely to make It through your entire life without developing ankle arthritis. Outside of some systemic conditions, the ankle joint does not really degenerate on its own, which is quite unlike hips, knees, and shoulders. The flip side of the coin, however, is that it only takes small amounts of misalignment or trauma to create long term effects. This is the main reason that we treat ankle injuries so aggressively. We know through years of research that ankle arthritis develops quickly in the face of neglected trauma. Simple ankle fractures where the smaller leg bone, the fibula, is broken can lead to arthritis within a year if there is any dislocation or shortening of any of the three bones involved.
This can likely all be attributed to the complex mechanics of the ankle joint. There are three bones which all must cooperate for the ankle to function correctly: the tibia, fibula, and talus. The talus sits between the other two and acts as a fulcrum to bend your foot up and down. The tibia and fibula also have motion between them, which allows for normal extension and rotation of the foot. After an ankle fracture, undergoing surgery can often provide the best chance of restoring this normal anatomy and preventing arthritis.
The most common cause of ankle arthritis, as we discussed, is a prior injury. While surgery does minimize the risk of developing arthritis, often the degree of cartilage damage is inescapable. Other common causes of ankle arthritis are systemic concerns like rheumatoid arthritis and long-term gout.
No matter the cause, there are several treatments ranging from conservative to some of the biggest surgeries we do as podiatrists. Generally, we would start with orthotics of the foot or ankle, supportive shoes, and possible ankle injections. Some patients are likely to have arthroscopic treatment to look at any loose debris or cartilage damage, which can sometimes be repaired early in the disease progression. More aggressive or definitive treatments include surgeries like ankle fusion or total ankle replacement, both of which are useful for end-stage arthritis.
The current gold standard treatment for ankle arthritis is ankle fusion, also called an arthrodesis. Taking away all of the motion at the joint eliminates the pain and alterations in gait. This is still the most predictable of procedures for this condition, though it is a significant surgery. Plates and screws are placed across the joint to prevent motion and stimulate bone growth across the site. The patient is kept off the affected foot for several months while it heals. As a thirty something year old doctor, this is the procedure I would want done on myself if I had this condition.
Ankle replacement, however, is quickly becoming a better option for more and more people. Historically, results of this surgery have been lackluster. They were reserved for minimally active, older patients who would likely not live long enough for the implant to fail. The biomechanics across the joint are largely responsible implant failure; for each step we take, we put several times our body weight across the ankle joint. With newer implants, the results are promising, though generally patients under sixty or those who remain active will benefit more from fusing the joint.
With all of the treatment options, it is very possible for patients with ankle arthritis to return to a reasonable activity level after treatment. Untreated, the condition can be debilitating, but no matter what stage of deformity you have, we at Eagle-Summit Foot & Ankle have several options that may be beneficial.