Ankle Arthritis: Treatment Options

Ankle Arthritis: Treatment Options

Similar to arthritis in other joints, ankle arthritis will only worsen with time if left untreated. Eventually, if all the cartilage in the joint is gone and there are only bone surfaces touching, the body will try to grow the two bones together, which is called a fusion. A joint fusion is actually a surgical treatment for severe arthritis, but let's focus on non-operative treatments first.

If the case of arthritis is mild enough, the patient can try different things to avoid surgery. Modifying their activities to avoid pain and switching to more comfortable shoes can help. Physical therapy can help improve stiffness and build strength in the ankle to keep it stable. Different types of braces can help provide support and non-narcotic medications can help provide pain relief. The health care provider may also recommend some type of injection for additional pain relief, if needed.

If these measures are not helpful and the patient continues to have pain, surgery may be the next step. There are many categories of surgery regarding treatment of ankle arthritis. A simple debridement, more commonly known as a cleanup procedure, would involve using a small arthroscope or camera and small instruments and trimming back bone spurs while trying to smooth out any remaining cartilage. This is usually used only as a temporary solution.

An ankle fusion, as mentioned before, is when a surgeon removes any remaining damaged cartilage and uses a combination of plates and screws to hold the bones together, waiting for them to fuse and become solid. Even though the ankle joint would no longer move, patients can still function quite well. Here is a video of a patient walking down the hallway after recovering from an ankle joint fusion. Their strides may be a bit slower and shorter, but walking and going up and down stairs can be done without a walker or cane.

If bad alignment of the ankle is contributing to the arthritis, a joint sparing realignment procedure can be done to straighten out the bones. Leaving the cartilage surfaces alone, hopefully delaying, or even avoiding an ankle replacement altogether.

If the arthritis is bad enough, but the patient doesn't want a fusion because they want to be able to move their ankle, then the surgeon may recommend a total ankle replacement. Similar to a knee or hip replacement, the surgeon removes the damaged cartilage surfaces, replaces them with metal surfaces, and puts a plastic layer between the metal.

In a case of severe arthritis of both the regular ankle joint and the subtalar joint, both joints can be fused together with one surgery. Sometimes a plate is placed on the outside of the bones to hold them together, but this has a risk of irritating the skin. A more recent development is a procedure where a rod is placed up through the bones and held in place with screws. With any of these procedures, a surgeon may use biologic augmentation to try and help the healing of the bones.

Because there are so many ways to treat ankle arthritis, a thorough discussion between the patient and surgeon must take place so that the right treatment can be chosen to return the patient to their desired activity level.