Living with ankle arthritis
By definition, arthritis means inflammation of one or more joints. Largely speaking there are two types of arthritis (osteoarthritis and rheumatoid arthritis) which are different from each other in the cause of the disease and specific treatment although their symptoms are mainly the same. In this article we will focus on osteoarthritis which is the most common type, and lies within the scope of orthopaedic surgeons, whilst rheumatoid arthritis is a chronic autoimmune disease that attacks multiple joints and ligaments; an area of expertise of the rheumatologists. In this case, the immune system unsuitably targets its own tissues and the treatment is largely based on drugs that regulate that immune response.
Independently of the type of arthritis the end result is the damage and loss of cartilage in the affected joint. The cartilage is a thin lining of smooth tissue that exists at the end of each bone when they meet to form a joint. Consequently any joint in the body may be affected by arthritis. Our joints are bathed by synovial fluid that lubricates the cartilage and together they ensure a shock absorbing effect and a reduction in friction. However, when a joint undergoes the process of arthritis, this cartilage gradually wears away and that protective effect is lost, resulting eventually in bone on bone arthritis which is logically very painful.
In the foot and ankle there are a multitude of joints and all of them are theoretically susceptible of developing arthritis. Some are more commonly affected than others and in our clinics the joints that present with arthritis more often are the ankle joint (tibio-talar joint), the big toe joint (metatarsophalangeal joint), or the midfoot joints (arthritis in top of foot). Joints affected by osteoarthritis have generally been subject to increased long-standing strain (deformities, overuse, repetitive trauma or fractures).
An arthritic joint will be painful and inflamed. The onset of pain tends to develop gradually and is aggravated during activity. However it can also present suddenly in cases of joint flare-ups. Other symptoms will include stiffness in feet and ankles, and a swollen joint. Characteristically, pain tends to be worse in the early mornings or when starting an activity after resting. Many people may feel an increase of joint pain when the weather changes.
During your appointment in clinic, your doctor will enquire about your symptoms and potential causes along with a focused medical history. A physical examination of the affected joints will be conducted and possibly diagnostic tests will be ordered, such as x-rays.
Foot / Ankle Arthritis Treatment
The treatment will be focused on the affected joint. As a degenerative condition, the lost of cartilage cannot be recovered, and as such there is no real cure for arthritis but there are a good number of treatments available to relieve pain or replace the damaged joint.
- Lifestyle – Reducing the stress going through the joint will help to ease-off the pain and avoid further progression. Losing weight, lower impact activities (like swimming or cycling), adequate and protective footwear are amongst some of the proven strategies.
- Medication – Drugs that tackle inflammation and relieve pain can be used but their side-effects need to be weighed out for any long term treatments.
- Injections – Steroids are powerful anti-inflammatories that are injected in the affected joint and reduce the side-effects of drugs that spread throughout the body. Other injectables like viscosupplements (hyaluronic acid – a natural component of joint fluid) are helpful in early stages of the disease whereas more modern options such as PRP (platelet-rich-plasma) and stem cells have shown promising results but are less predictable and clinical studies are still in progress.
- Physiotherapy – Exercises that specifically target some muscles around the ankle and help strengthening them or stretches to reduce stiffness.
- Braces – An ankle support for arthritis will alleviate some pain and protect the joint.
- Podiatry – Given that quite often the underlying cause can be pinned down to a biomechanical imbalance, a podiatry review with gait analysis and potential insoles will help to correct any deformities.
Surgery for Ankle Arthritis
Surgery can be a good option for patients with a disability caused by arthritis that is not relieved by non-surgical treatments. Different types of surgery are available depending on the stage of the condition and your surgeon will discuss those that may benefit you the most. Arthroscopy can be used to address some small areas of damaged cartilage. An osteotomy (leg realigning) that shifts the weight away from the damaged area can be successful in early stages. When the joint is damaged beyond repair either a fusion or a replacement will be indicated with their pros and cons and different recovery times.
So in a nutshell, arthritis is wear and tear of a joint (the smooth cartilage lining becomes rough or wears out completely down to bone). When that happens we can try and reduce the inflammation or movement in that particular joint, although the lost cartilage cannot be build back. When advanced, a good solution would be a joint replacement (for mobile joints) or a fusion (for stiff ones).