Ankle arthritis

Ankle arthritis refers to damage to the smooth cartilage which normally lines the ankle joint. This can be caused by wear and tear, as a result of a previous injury, or can come on for no obvious reason. It sometimes runs in families. It typically affects people in their 60s and 70s, but not uncommonly affects younger adults, particularly those involved in a lot of contact sports. When the cartilage wears down to bare bone the condition becomes serious.

ankle joint
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What does ankle arthritis feel like?

You may well have ankle arthritis if you experience stiffness in the ankle and you struggle to bend the foot fully upwards or downwards. It may be painful in certain positions and may become painful walking. Stairs and gradients can be really bad because they force the ankle to move more, and squatting can be tough. To start with this is worse with activities, and you may see or feel swelling in the ankle. The pain is typically a dull aching pain a bit like a toothache. In the early stages anti-inflammatories or painkillers will help, but as the condition progresses these become less effective.

Often the ankle gets stiff and you get pinching sensations at the front or back. This can make hills and gradients harder than walking on the flat.

What can you do?

The treatments for ankle arthritis are the same as for other sorts of arthritis in general terms. When it is not too bad then pain killers and anti-inflammatories can help. Also ankle supports or braces, the right sort of shoes and sometimes insoles can help.

The next step up is injection therapy and I often inject patients either with Viscosupplement injections like Durolane, or Platelet Rich Plasma (PRP). Both of these are really good options if you have early arthritis. You can read more about injection therapy here.

The next option after that is surgery. I don’t do ankle surgery for arthritis, but the options range from keyhole surgery to trim off bone spurs, to ankle replacement or even ankle fusion.

If things get this bad then I will refer you on to a colleague who specialises only in ankle surgery in the same way that I specialise in knees.

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Frequently asked questions

In the early stages of arthritis painkillers, physiotherapy, and ankle braces can be helpful. As the condition progresses injections of replacement joint fluid (Durolane) can be really useful. Keyhole (arthroscopy) surgery can be very effective for early arthritis to remove bone spurs at the front of the ankle (an operation called cheilectomy).

Luckily the ankle seems to tolerate more wear than other joints before it becomes really bad. However with time, arthritis may affect your mobility, and your walking distances. It will impact on your lifestyle and impair quality of life. It may become painful at night-time and keep you awake at night or wake you up from sleep. When the symptoms reach this level it is time to consider having surgery.

There is an important choice to make between having the joint fused (arthrodesis), which means there will be no movement in the ankle itself, and no pain, or an ankle replacement. Unfortunately, the ankle replacement technology is a long way behind that of hip and knee replacements, the lifespan of these joints is not as good. For that reason, ankle fusion is still a popular choice especially for younger patients in whom ankle replacement may only last a few years before causing problems. Ankle fusion is not as bad as it sounds, the remaining joints in the back of the foot compensate for the loss of motion at the ankle and allow relatively normal movements. Usually, by the time this surgery is considered, there is very little motion in the ankle joint anyway because of arthritis. Many people with an ankle fusion return to their previous sports.

If you think you have ankle arthritis it is well worth getting in touch with me and having it looked at sooner rather than later. I don't do ankle surgery for arthritis, but I do help a lot of people with early arthritis with injection therapy, and I am able to give advice about how to avoid surgery and keep you active. If you do really need surgery I can guide you to the best surgeon for you and avoid the not so good ones!