Osteoarthritis
Osteoarthritis of the ankle and hindfoot – when malalignment loads the joint
In osteoarthritis of the ankle or the hindfoot the joint cartilage is increasingly worn. That can cause pain, restricted movement and a growing uncertainty under load. The arthritis often develops as a consequence of a malalignment of the foot or ankle, after earlier injuries, or because of changes present from birth. Where the joint surfaces are badly damaged and the symptoms persist despite conservative treatment, surgically fusing the affected joint – an arthrodesis – can be worthwhile. The aim is to reduce pain and to give the foot a stable position that carries load again.
Osteoarthritis can in principle affect people of any age. With malalignment present from birth, or with marked deviations of the axis, joint wear can appear in younger years. It can also develop progressively after injuries or after years of uneven loading. What decides the treatment is the extent of the joint wear, the malalignment present and the individual symptoms.
How osteoarthritis develops
Osteoarthritis develops when the protective layer of cartilage in a joint is increasingly damaged. At the ankle and hindfoot, malalignment can concentrate the load permanently on individual parts of the joint. That encourages wear, which can increase over time.
- Malalignment of the foot or hindfoot present from birth
- Malalignment after injuries or operations
- Permanent uneven loading of individual parts of a joint
- Advanced cartilage wear in the ankle or hindfoot
- Instability and altered loading axes of the foot
- Repeated overloading where a malalignment is present
Symptoms
The symptoms depend on which joint is affected and how far the arthritis has progressed. Typical are pain under load and a growing restriction of movement.
Pain under load
Pain arises above all when walking, standing for longer periods or on uneven ground.
Restricted movement
The ankle or the hindfoot becomes increasingly stiff and movement becomes harder.
Malalignment
A growing malalignment can change the loading and increase both pain and instability.
Treatment options for osteoarthritis of the ankle and hindfoot
Treatment depends on the symptoms, the extent of the joint wear and the underlying malalignment. With milder symptoms, joint-preserving measures can be used first. With far advanced arthritis, pronounced pain and malalignment, surgical treatment may become necessary. The aim of an arthrodesis is to stabilise the painful, worn joint for good. At the upper ankle joint there is additionally the option of implanting an ankle replacement.
When deciding on an arthrodesis, the joints affected, the position of the foot and the loading axis are assessed carefully. Individual planning matters particularly with malalignment present from birth, or with complex malalignment after earlier operations.
Therapy options
Joint-preserving and surgical – matched to the cause and the extent of the arthritis
Taking load off and adapting it
Depending on the symptoms, measures to take load off and adapt it can be used first. The aim is to reduce pain and to preserve everyday function for as long as possible.
Footwear and orthopaedic aids
Adapted footwear or orthopaedic support can change the load on the affected joint and take weight off the foot in everyday life.
Correcting the malalignment
Where a pronounced malalignment underlies the joint wear, correcting it can be part of the surgical treatment. Exactly how depends on the individual anatomy and on the joints affected.
Arthrodesis of the affected joint
With advanced arthritis the badly damaged joint is surgically fused. The aim is to switch off painful movement and to achieve a stable position of the foot that carries load.
Complex hindfoot arthrodesis
With advanced wear in several hindfoot joints, fusing more than one joint can be necessary. The aim is a less painful and stable loading of the foot. At the upper ankle joint, replacing the joint is additionally possible.
Total ankle replacement
At the upper ankle joint there is additionally the option of implanting an ankle replacement instead of fusing the joint. Which way comes into question is assessed from the joints affected, the position of the foot and the loading axis.
Frequently asked questions
What is an arthrodesis?
When is an arthrodesis of the ankle or hindfoot worthwhile?
Can a malalignment cause arthritis?
What happens to movement after an arthrodesis?
Is an arthrodesis also possible with malalignment present from birth?
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