What is arthritis?

Ankle osteoarthritis is a joint condition which results from damage and loss of the cartilage in a joint. Cartilage is a highly specialised type of tissue which lines the end of bones and allows smooth movement of joints. Loss of, or damage to the cartilage results in inflammation of the joint and can sometimes lead to deformity.

In the foot, osteoarthritis most commonly occurs in the big toe, the middle of the foot and the ankle.

What symptoms may I feel?

Ankle osteoarthritis can cause stiffness, pain, swelling, and deformity. Some patients will develop a bony protrusion known as an osteophyte or bone spur and this can lead to pinching of the lining of the joint and this is known as impingement.

In common with osteoarthritis elsewhere in the lower limbs (eg hip and knee), osteoarthritis of the ankle can limit the amount of walking and standing an individual can do.

In the early stages, pain may only occur at the beginning and at the end of an activity but as the condition progresses the pain occurs more frequently to the extent that it can occur with each step and even at rest.

What causes it?

The commonest cause of ankle osteoarthritis is “post-traumatic” and can develop following a fracture of the ankle or even just repeated sprains. Unlike the hip and knee where osteoarthritis often occurs for no identifiable reason (primary OA), the ankle rarely develops arthritic changes without an identifiable cause.

The ankle is a complex joint which is subjected to huge forces during daily activities and especially during running. It is also the joint most commonly injured in the human body. This combination of factors predisposes the ankle joint to wear and tear changes.

Other causes of osteoarthritis are abnormal foot mechanics (flat and high-arched feet) and there are some diseases associated with arthritis such as haemochromatosis.

How is it diagnosed?

The diagnosis of ankle osteoarthritis is made on the basis of the history and examination by an orthopaedic surgeon and is confirmed with weight-bearing X-rays (below). Sometimes other imaging such as MRI can be helpful in the early stages.

What are my treatment options?

Non-surgical treatment of ankle osteoarthritis should always be considered first as it might provide sufficient pain relief. This includes footwear modification, anti-inflammatory medication and physiotherapy in order to allow more flexibility and greater activity. Injections to lubricate the ankle joint or cortisone to damp down inflammation can help but at best their effect is only temporary. If conservative treatment fails to provide sufficient pain relief, surgery may be necessary.

The type of surgery will depend on a number of factors:

• Your age
• The amount of tilting of the ankle joint
• Your Surgeon

Essentially there are three options, firstly an arthroscopy and debridement (tidy up). This is successful in very early cases, where the amount of wear and tear is minimal. Ankle fusion and ankle replacement remain the two most common options for more severe cases.