Degenerative arthritis of the ankle is most often the result of a previous traumatic injury such as a fracture. The onset of symptoms can be many years after the initial injury. Primary arthritis of the ankle can also occur, and rheumatoid arthritis can also cause arthritic pain. The most common complaints are stiffness, swelling, and localized pain. The symptoms are often most severe in the morning, after being immobile for several minutes and then starting activity again, or with changes in the weather (rain or cold). X-rays are useful to confirm the diagnosis and determine the extent of involvement.
Initial treatment is normally to begin the use of an anti-inflammatory medication and possibly a lightweight brace to support the ankle. In patient who continue to have pain, more aggressive measures are needed. Steroid injection into the painful joint can be helpful in alleviating symptoms. Occasionally shoe modifications can be used. Custom braces are also helpful in certain situations. If none of these measure is successful, then surgery may be indicated. For milder arthritis, arthroscopy of the ankle joint can be performed as an outpatient procedure to remove spurs and loose bodies from the ankle joint (“clean out the joint”).
Definitive treatment is often to either fuse the ankle or perform ankle replacement. The goal of both is to reduce pain, but each procedure accomplishes this differently. A fusion reduces pain by permanently immobilizing the joint where the painful surfaces do not constantly rub against each other with activity. The sacrifice is a loss of motion to the ankle, although ankle motion with arthritis is often limited before surgery. Replacement of the ankle joint works much like a knee or hip replacement where the arthritic surfaces are replaced by a mechanical joint to allow motion but eliminate the arthritic pain. The advantage is retaining some motion to the ankle, but this procedure could require additional surgery in the future if there is any mechanical problem with the joint or if the joint “wears out”. The joint replacement could then either be revised to a new joint replacement or converted to a fusion, depending on the individual circumstances. The primary indications for a joint replacement are age greater than 50 years, no deformity, no significant obesity, no history of diabetes or previous infection of the ankle.