Ankle arthritis or osteoarthritis is pain in the ankle caused by long-term wear and tear. Osteoarthritis is a process where the cartilage, or smooth surface lining the joint is rubbed away. Once this occurs, the underlying bone is irritated and becomes inflamed and painful.
Ankle arthritis is very common, especially in elderly people. It is more likely to occur in people with a history of ankle injury, especially fractures.
Often, arthritis can be treated by taking care of yourself, taking pain medications or wearing supportive soft shoes. Occasionally, surgery is required.
Symptoms
Osteoarthritis is associated with:
- Pain in one or both ankles. This is often worse at the end of the day after walking around. It may be relieved by simple over-the-counter pain medication and ice.
- Some swelling
- Stiffness
If you experience other symptoms, like redness and warmth, you may have other conditions that are sometimes mistaken for simple osteoarthritis:
- Rheumatoid arthritis – sometimes affects the ankle and feet, usually left and right together. In rheumatoid, short episodes of mild to severe pain occur. This is different to osteoarthritis, which is usually a constant, gradually worsening process.
- Gout & pseudogout – similarly to rheumatoid arthritis, these affect different joints in the body with episodes of pain.
- Septic arthritis – there are a number of different infections that can affect joints. Often, but not always, fever, redness and swelling are associated with pain.
- Neuropathic Arthritis
Causes
Ankle arthritis is caused by wear and tear on the cartilage in the joint.
If the ankle has suffered injury earlier in life, like fractures, rheumatoid arthritis, gout and recurrent sprains, the joint surfaces are likely to rub against each other abnormally. This makes the development of arthritis more likely.
Other disease affecting the joint, like infection or haemarthrosis (bleeding into the joint) can also provoke damage to the cartilage that develops into arthritis in later life.
If you’ve had surgery in the rest of your foot, for example fusion operations of the big toe or in the heel, you are more likely to develop arthritis because the forces acting through your ankle are imbalanced.
Risk Factors
Arthritis can occur at any age, but is more likely to affect older people. Other factors that increase the risk of developing arthritis include:
- Injury. Ankle fractures, dislocations and repetitive sprains can all change the way the joint fits together. A poorly fitting joint tends to rub some areas of cartilage more than others, kick-starting the process of arthritis. This is so common it is called ‘post-traumatic arthritis’.
- Diabetes
- Obesity
Other surgeries in the foot, in particular fusion operations across the heel and back part of the foot make arthritis in the ankle more likely.
Investigations
Your doctor can assess your arthritis by listening to your symptoms and examining your ankle. Tests that may be helpful include:
- X-Rays.
- Rarely, more advanced images are required – CT scans and MRI.
- Blood tests.
- Needle aspirate of the joint. The ankle is affected in conditions like gout and pseudogout, and if this is suspected your doctor may take a sample of your joint fluid through a needle.
Complications
Complications of arthritis are pain and swelling developing in other joints, and inflammation spreading into the soft tissues forming the joint (synovitis). This can cause your joint to become hot, red and swollen and very painful.
Treatment
The treatment plan for arthritis will vary depending on the severity of your pain and the level of your activity.
There are three broad arms of treatment: medications & injections, physical therapy and surgery. Splints, medication, injections and minor surgery like arthroscopy are often used in combination. When these methods begin to fail, you may need fusion surgery (arthrodesis) or ankle replacement.
While you’re waiting to see a doctor, you can try these at-home care methods:
- Rest and avoid activities that aggravate your ankle. Try to wear wide, comfortable shoes. This, however, does not mean complete bed rest, and should instead try to gently move your ankle when it is not painful.
- If you notice swelling in your ankle, you can reduce this by applying ice and elevating your ankle.
- Apply ice to the injured area for up to 20 minutes, several times a day. Ice packs, ice massage or ice water slush baths all can help. For an ice massage, freeze a plastic foam cup full of water so that you can hold the cup while applying the ice directly to the skin.
- Keeping your ankle elevated on several pillows while you’re sleeping is a great way to bring down swelling.
You can also try nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen or products containing paracetamol to try to reduce pain.
Be sure to talk to your doctor if you feel you need NSAIDs for an extended time because some of these drugs should be used for only short periods — around seven to 10 days — to avoid complications.
Injections
Your doctor may also suggest an injection of steroids and/or anaesthetic into the joint. This helps to reduce inflammation, relieving pain and swelling as well as helping prevent further injury in your ankle.
As effective as injections frequently are, they need to be repeated often (once every few months) to maintain their effect. For this reason, you may be referred on to further treatment.
Physical Therapy & Orthotics
If you’ve tried self-care measures, such as rest, ice and over-the-counter pain relievers and they aren’t working for you, your doctor may suggest other physical therapy:
- Shoe inserts – Orthotics.
- Shoe modifications.
- Your orthotist, podiatrist or surgeon may recommend you try a special shoe design called a ‘rocker bottom‘ shoe. The sole of this type of shoe forms a smooth, soft curve along its bottom edge. It helps reduce the strain on the ankle by gently rolling the foot from heel to toe as you walk.
- Shoes with a stiff sole and well-padded heel are also very useful for arthritis.
- Taping.
- Braces / splints. When shoe inserts fail to help with arthritis, using a lower-leg to foot brace that keeps the ankle from moving too much can be helpful. Your specialist may recommend that you wear this brace for a number of weeks until the inflammation in your ankle goes down.
- Physiotherapy. Strengthening the muscles in your calf and leg can help to balance the forces acting around your ankle.
Surgery
When the above treatments fail to control the symptoms of arthritis, you may start considering surgery.
There are a number of surgical options for the treatment of severe arthritis:
- Arthroscopy. This is a form of keyhole surgery that allows the surgeon to see and assess the inside of your ankle. From here, the joint can be flushed and any damaged cartilage trimmed away. This is a very effective method of treating the symptoms of arthritis. It is not a definitive method however, and repeat arthroscopy or more aggressive surgery may be needed in later years.
- Ankle Arthrodesis. Fusion of the ankle is a very effective method of stabilising the foot and relieving pain. The disadvantages of this method are that all movement at the ankle is lost, making activities like running impossible. Despite this, most people are very happy with their results from fusion.
- Total Ankle Replacement. Replacing the ankle provides a moving joint, but tends to have higher rates of requiring revision surgery later in life.
Seeking Advice
If the pain in you ankles is starting to make walking difficult, you should talk to your local healthcare provider.
In the meantime, you can use simple treatments like rest, ice and keeping your foot elevated at night time. Over the counter medications like panadol can also help relieve pain.
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
You can take care of your ankles by maintaining a healthy weight and wearing shoes that are comfortable and supportive.