Ankle Arthritis

Introduction to Ankle Arthritis

The ankle joint is an important joint in the function of gait and mobility. A significant amount of force and pressure are imparted upon this joint with each step. Its complex construct takes on these forces while having most of its motion in a flexion direction and keeping its rigidity in side-to-side and rotation motion. It has a mortise type of anatomy that makes it more complex than the hip or knee joints. The bones that make up the ankle joint are: the Talus (ankle bone), the Lateral Malleolus of the Fibula (outer leg bone), the Tibial Plafond (leg bone), and the Medial Malleolus of the Tibia (inner leg bone). Destruction and deterioration of the cartilage surfaces within the joint will lead to ankle joint arthritis over time. The degree of arthritis and destruction of the joint is determined by the time and type of injury or deformity that first lead to the arthritis. Arthritis, or degenerative joint disease (DJD), of the ankle joint can be greatly debilitating, leading to pain, decreased activity, decreased quality of life, and immobility. As the population ages, there is a greater need for joint replacement surgery and the ankle is no exception.


Side view of ankle arthritis	Front view of mild ankle arthritis

What is Ankle Arthritis

Arthritis is a disease of the joints. It is simply a deterioration and destruction of the cartilage within the joint. Cartilage is the smooth, thin layer of soft tissue that covers the surface of bone on either side of a joint. The only reason that the two bones do not simply fuse together (like when a fracture mends) is because the cartilage is in the way of the bones fusing together. Any part of the body that moves involves a joint with cartilage. In order for the 2 bones to move over one another, cartilage needs to be present over the bones. Cartilage takes on a great deal of pressure and force and can absorb these forces very efficiently. However, cartilage is not strong when there is a sheering force applied to it or when it is fractured. Arthritis is a progressive disease that will compound on itself. Even a small amount of damaged cartilage leads to an uneven amount of pressure within the joint, and the bones will move upon the damaged surface and erode more and more of the cartilage until there is more bone contact. There are many types of arthritis. For example, rheumatoid arthritis is one that is genetic and effects all parts of the body equally. Osteoarthritis, or degenerative joint arthritis (DJD), is one that is caused by trauma to one or more specific joints.

Front view of ankle showing arthritis

Causes of Ankle Arthritis

Any trauma to the joint can potentially damage the cartilage of the ankle joint. The trauma can be acute as in a fractured ankle, or over time like with overuse in sports. When there is a constant overuse and impact on the joint surface, over time the cartilage will break down. The breakdown of the cartilage will lead to even more breakdown, causing a decrease in the range of motion at the ankle. This loss of motion can lead to further breakdown as the bones continue to wear on one another.

Symptoms of Ankle Arthritis

The symptoms of ankle arthritis are mainly pain and decreased range of motion. The pain comes from the fact that there is movement in a damaged joint. It is the movement that ensues pain. As the joint becomes increasingly damaged, the bones will rub on one another in such a way to cause irritation and inflammation within the joint. As the joint fluid becomes inflamed, this is called synovitis, the nerves that are part this inflammatory reaction become over stimulated, leading to pain. The loss of motion is due to the fact that when there is less cartilage, there is nothing protecting the bones from one another and they simply get in the way of one another. The joint moves less, creating stiffness and increased irritation and pain. As the movement decreases the joint can change shape and flatten, making it even more difficult for the bones to move. Bone fragments and spurring can also be created as the motion decreases. This will also lead to decreased motion and pain.

Diagnosis of Ankle Arthritis

The clinical examination is used to determine the level of joint movement and range of motion. An analysis of the patient's gait will also be important to evaluate if there has been any compensation for the problem at the ankle. Plain radiographs, x-rays, are used to evaluate the bone and the joint directly. Multiple views are taken at different angles to determine the degree of arthritis and to see if any other joints are involved. CT and MRI scans may be helpful in determining any angular deformities as well as determining the amount of bone stock or if there are any cystic formations within the bone. An MRI can also show the degree of cartilage loss to the bone surface and in what location.


Side ankle view showimg dorsal exostosis	Front ankle view showing severe ankle arthritis

Treatment Options for Ankle Arthritis

There are several different treatments for ankle arthritis from conservative to surgical treatments. Determining the correct treatment for each individual patient will depend on many factors. There is no one way to correct or treat the damaged cartilage. It is typically a stepwise approach to treatment. The determining factor is often the degree of damage to the joint. It is important to remember that there is no one cure for arthritis.

University Foot and Ankle Institute is a world leader in the diagnosis and treatment of ankle arthritis. From conservative bracing made on site to ankle replacement surgery there is no form of ankle arthritis to small or to large for us to treat.

Treatment options for ankle arthritis include: