ANKLE OSTEOARTHRITIS
Ankle osteoarthritis – when the cartilage in the upper ankle joint wears through
The upper ankle joint carries a multiple of the body weight with every step, and over a very small area. Its cartilage is built for that – thicker and more resilient than the cartilage in the knee. Which is why the ankle hardly ever wears out on its own.
When it does, an injury is almost always behind it: a fracture that did not heal perfectly smoothly, a cartilage defect on the talus, or years with an unstable ligament. About one per cent of adults have painful osteoarthritis of the upper ankle – and many of them are younger than one would expect with arthritis.
How it comes about
Unlike the hip and the knee, ankle osteoarthritis is usually not a sign of age but the late consequence of an event. Ten or twenty years can lie between the accident and the first symptoms.
- A healed ankle fracture, especially if a step was left within the joint
- A cartilage defect on the dome of the talus
- Repeated giving way with chronically unstable outer ligaments
- A malalignment of the leg axis or hindfoot that loads the joint on one side
- Inflammatory joint disease such as rheumatoid arthritis
- Impaired blood supply to the talus after an injury
Symptoms
The symptoms come on slowly and over years. Typically the first step after getting up hurts the most, and it eases after a few metres.
Start-up pain
The first steps after sitting, or in the morning, are the worst. Later, pain also comes under load and finally at rest.
A stiff joint
The foot no longer lifts as far. Walking uphill, squatting or climbing stairs is what you notice first.
Swelling
The joint swells after loading and feels warm. It is more noticeable with a change in the weather or after long days.
When not to wait
Osteoarthritis is not an emergency. It is, however, a reason to look early: as long as the malalignment driving it can still be corrected, the course can be influenced – by an osteotomy, say, or by stabilising the ligaments. Once the cartilage has gone entirely, only the major solutions remain.
Anyone left with lasting symptoms after an ankle fracture should not accept that as normal. A step of a few millimetres within the joint is enough to use up the cartilage over years.
Treatment options
Conservative treatment comes first: a rocker sole that takes movement off the joint, insoles to correct the position of the hindfoot, physiotherapy, anti-inflammatory medication and, where needed, an injection into the joint. That can buy years.
When it is no longer enough, there are two major routes. A **replacement** resurfaces the destroyed joint and preserves movement. A **fusion** gives up the movement and trades it for a reliably pain-free joint. Which route is right depends on age, bone quality, ligament stability, alignment and what you ask of the foot – we discuss that without hurry.
Therapy options
Redirect the load first – joint replacement comes at the end, not the beginning
Insoles and shoe adaptation
A rocker sole takes part of the movement away from the ankle; evening out the position of the hindfoot spreads the load again.
Orthosis
A below-knee orthosis guides the joint and damps the painful end-range movements – often the alternative when surgery is not an option.
Injection into the joint
Hyaluronic acid or anti-inflammatory agents can settle an irritated phase. They build no cartilage, but they buy time.
Total ankle replacement
Three components replace the destroyed joint surfaces. The joint stays mobile, the gait pattern is largely preserved, and the neighbouring joints are not loaded on top.
Frequently asked questions
Surely I am far too young for arthritis?
Replacement or fusion – which is better?
How long does an ankle replacement last?
Can I do sport afterwards?
Does an injection help?
Do I have to decide straight away?
Our ankle specialists
Experienced specialists in osteoarthritis and replacement of the upper ankle joint
