The ankle joint is composed of three different bones: the tibia, fibula, and talus. These three bones are held together by a series of ligaments and together function as the ankle joint. The main function of the ankle joint is to allow for the up and down (dorsiflexion/plantarflexion) motion of the ankle. Arthritis is when the cartilage is damaged or worn away and no longer provides the cushion to allow the smooth motion between the bones. Cartilage is unique in that there is no blood flow that provides nutrition, so that when injured it does not have the ability to repair itself very well, unlike bone. This inability to repair itself is why scientists and surgeons have a very difficult time in trying to restore large cartilage defects in the setting of arthritis. The most common reasons for ankle arthritis include: trauma (fractures/dislocations), ankle instability, deformity, autoimmune arthritis, and what is called idiopathic (no known cause - or wear and tear).
Diagnosing ankle arthritis begins with a thorough history, focusing on the location of the pain and what causes aggravation. In many patients the pain presents along the front of the ankle joint. “Start up” pain occurs in the morning or when a patient has been in one position for a prolonged time such as sitting in a car. The ankle joint becomes stiff and can hurt for the first few steps while the joint “loosens” up the joint. Although there is no perfect answer for this, some of the reason is felt to be that the joint lining called the synovium begins to produce joint fluid more when you are moving and this helps to minimize the pain after a few minutes. This may be why many patients with ankle arthritis prefer a little walking to standing in one place. The physical exam is particularly focused on how much motion is left in the ankle joint. Not all of the up and down motion of the foot is from the ankle, and the remaining motion of the ankle does help to determine what surgery would be better for the patient. Additionally any deformity, such as a high arched foot or flatfoot is noted as this can impact the nonoperative and operative options. The location of the pain is in the front of the ankle is confirmed in addition to other joints that might be painful, so that a complete understanding of your problematic areas can be understood and an effective treatment plan can be created. Xrays are taken to confirm the presence of arthritis and evaluate the biomechanical alignment of your foot and ankle. Additional testing such as a CT scan and MRI may be considered
Treatment of ankle arthritis is focused on your needs based on your pain and desired level of activity. Non-surgical treatment focuses on minimizing the strain and stress across the ankle with the use of semi-rigid or rigid ankle braces. The braces cannot improve the lack of cartilage, however, can help to minimize your pain. Injections can help in many patients and provide relief, however, rarely are they able to provide a long-term solution in isolation. Injections can include steroid and PRP (platelet rich plasma) depending on the severity of the arthritis. Shoewear and activity modification can also help to minimize the stress across the joint and help to provide symptom relief and avoid surgery. In patients that do not obtain relief or the restrictions are not amenable or acceptable to their desired lifestyle or work demands, surgical options can be considered. In very mild cases of ankle arthritis, joint preservation with mechanical stabilization and spur removal combined with concentrated bone marrow aspirate (autologous stem cell) therapy is considered. In more severe cases, the most appropriate options are either ankle replacement or ankle fusion. We perform both of these procedures and are also experienced in treating referred patients that have had either procedure before and unfortunately have continued pain. There is no one perfect operation since both ankle replacement and ankle fusion provide relief of pain and improvement in function in the right patient. Each patient must be individualized with regards to their desired level of activity/expectations, the deformity present, amount of ankle motion and many other factors in order to determine what option is best for them. We believe in a shared decision making process and this is extremely important when considering an ankle replacement versus ankle fusion.
Our Published Literature Related to Arthritis of the Ankle
1. Anatomic Risk To The Neurovascular Structures With A Medially Based All-Inside Syndesmosis Suture Button Technique. Journal Of Foot & Ankle Surgery. (2020)
2. Reconstruction Of Malunited Ankle Fracture. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
3. Ankle Arthrodesis. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
4. Arthritis Of The Ankle. Essential Orthopaedics. (2019) - Book Chapter
5. Osteotomy Of The Tibia & Fibula. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
6. Revision Total Ankle Replacement. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
7. Total Ankle Replacement. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
8. The Use Of Bulk Fresh Osteoarticular Allografts In Ankle Reconstruction. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
9. Tibiotalocalcaneal & Pantalar Arthrodesis. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
10. Disorders Of The Foot & Ankle. Miller’s Review Of Orthopaedics. (2019) - Book Chapter
11. Overview Of The Ankle & Foot. Essential Orthopaedics. (2019) - Book Chapter
12. Cavus Foot Correction. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
13. Outcomes Of Surgical Treatment Of Talar Osteochondral Lesions Using Bone Marrow Aspirate & Microgenized Allograft Cartilage Extra-Cellular Matrix. Foot & Ankle Orthopedics. (2019)
14. Management Of Osteochondral Lesions Of The Talus. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
15. Biomechanical Analysis Of Instability In Rotational Distal Fibula Fractures (OTA/AO 44-B1) With An Intact Deltoid Ligament. Journal Of Orthopaedic Trauma. (2019)
16. Deltoid Ligament Repair Reduces & Stabilizes The Talus In Unstable Ankle Fractures. Journal Of Orthopaedics. (2019)
17. Ankle Fractures: Open Reduction Internal Fixation. Key Techniques In Orthopedic Surgery. (2018) - Book Chapter
18. Prospective Patient Reported Outcomes (PRO) Study Assessing Outcomes Of Surgically Managed Ankle Fractures. Foot & Ankle International. (2019)
19. Outpatient Management Of Ankle Fractures. Orthopedic Clinics Of North America. (2018)
20. Leg, Ankle, & Foot Diagnosis & Decision-Making. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
21. Imaging Of The Foot & Ankle. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
22. Operative Treatment Of Posterior Malleolar Fractures. Open Orthopeadics Journal. (2017)
23. Management Of Acute Injuries Of The Tibiofibular Syndesmosis. European Journal Of Orthopaedic Surgery & Traumatology. (2017)
24. Predictors Of Patient-Reported Function & Pain Outcomes In Operative Ankle Fractures. Foot & Ankle International. (2017)
25. Role Of Spring & Deltoid Ligament Reconstruction For Adult Acquired Flatfoot Deformity. Techniques In Foot & Ankle Surgery. (2017)
26. Chronic Syndesmotic Injuries & Reconstruction. Techniques In Foot & Ankle Surgery. (2017)
27. Anterior Approach For Ankle Arthrodesis. Journal Of Bone & Joint Surgery Essential Surgical Techniques. (2017)
28. Total Ankle Arthroplasty Versus Ankle Arthrodesis-A Comparison Of Outcomes Over The Last Decade. Journal Of Orthopaedic Surgery & Research. (2017)
29. Total Ankle Arthroplasty Versus Ankle Arthrodesis-A Comparison Of Outcomes Over The Last Decade. Journal Of Orthopaedic Surgery & Research. (2017)
30. Guest Editorial: Soft Tissue Reconstruction In The Foot & Ankle. Techniques In Foot & Ankle Surgery. (2017)
31. A Biomechanical Comparison Study Of A Modern Fibular Nail & Distal Fibular Locking Plate In AO/OTA 44C2 Ankle Fractures. Journal Of Orthopaedic Surgery & Research. (2016)
32. A Novel Algorithm For Isolated Weber B Ankle Fractures: A Retrospective Review Of 51 Nonsurgically Treated Patients. Journal Of The American Academy Of Orthopaedic Surgeons. (2016)
33. Safety & Outcomes Of Inpatient Compared With Outpatient Surgical Procedures For Ankle Fractures. Journal Of Bone & Joint Surgery. (2016)
34. Open Reduction & Internal Fixation Of Ankle Fractures. Operative Techniques In Foot & Ankle Surgery. (2016) - Book Chapter
35. Ankle Syndesmosis Injuries. Advanced Reconstruction Foot & Ankle. (2015) - Book Chapter
36. Branching Patterns Of The Superficial Peroneal Nerve: Implications For Ankle Arthroscopy & For Anterolateral Surgical Approaches To The Ankle. Journal Of Foot & Ankle Surgery. (2015)
37. General Principles. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
38. Generalized Conditions. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
39. Disorders Of The Foot & Ankle. Miller’s Review Of Orthopaedics. (2015) - Book Chapter
40. Acute & Chronic Injuries To The Syndesmosis. Clinics In Sports Medicine. (2015)
41. Osteochondral Allograft Transplantation In The Ankle: A Review Of Current Practice. Orthopedic Research & Reviews. (2015)
42. A Comparison Of 30-Day Complications Following Plate Fixation Versus Intramedullary Nailing Of Closed Extra-Articular Tibia Fractures. Injury. (2015)
43. Arthroscopic Transfibular Approach For Removal Of Bone Fragments In Posterior Malleolar Fracture: Technical Tip. Foot & Ankle International. (2015)
44. Evaluation Of Posterior Malleolar Fractures & The Posterior Pilon Variant In Operatively Treated Ankle Fractures. Foot & Ankle International. (2014)
45. Isolated Adult Tillaux Fracture: A Report Of Two Cases. Journal Of Foot & Ankle Surgery. (2014)
46. Relationship Among Radiographic Ankle Medial Clear Space, Sex, & Height. Orthopedics. (2014)
47. Posterior Pilon Fractures: A Retrospective Case Series & Proposed Classification System. Foot & Ankle International. (2013)
48. The Cavus Foot. Foot & Ankle Clinics. (2013)
49. Why Allograft Reconstruction For Osteochondral Lesion Of The Talus? The Osteochondral Autograft Transfer System Seemed To Work Quite Well. Foot & Ankle Clinics. (2013)
50. Posterior Malleolus Fracture. Journal Of The American Academy Of Orthopaedic Surgeons. (2013)
51. Variability In Radiographic Medial Clear Space Measurement Of The Normal Weight-Bearing Ankle. Foot & Ankle International. (2013)
52. Radiographic Evaluation Of The Normal Distal Tibiofibular Syndesmosis. Foot & Ankle International. (2012)
53. Valgus Malalignment: What Joints To Address? Foot & Ankle International. (2012)
54. Ankle Fractures. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
55. Arthritis Of The Foot & Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
56. Introduction To Arthroscopy Of The Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
57. An Anatomical Way Of Treating Ankle Syndesmosis Injuries. Journal Of Foot & Ankle Surgery. (2011)
58. Introduction To Magnetic Resonance Imaging Of The Foot & Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
59. Chronic Ankle Instability. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
60. Acute Ankle Ligament Injuries. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
61. Osteochondral Lesions. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
62. Tophaceous Pseudogout Of The Ankle: Case Report. Foot & Ankle International. (2011)
63. Surgical Strategies: Doubled Allograft Reconstruction For Chronic Syndesmotic Injuries. Foot & Ankle International. (2010)
64. Novel Reconstruction Of A Static Medial Ligamentous Complex In A Flatfoot Model. Foot & Ankle International. (2010)
65. Effect Of Ankle Flexion Angle On Axial Alignment Of Total Ankle Replacement. Foot & Ankle International. (2010)
66. Malunion & Nonunion In Foot & Ankle Surgery. Foot & Ankle Specialist. (2010)
67. The Foot & Ankle. Sports Medicine & Arthroscopy Review. (2010) - Book Chapter
68. Correction Of Multiplanar Deformity Of The Foot & Ankle. Preface. Foot & Ankle Clinics. (2009)
69. Overview Of The Ankle & Foot. Essential Orthopaedics. (2009) - Book Chapter
70. Ankle Injection. Essential Orthopaedics. (2009) - Book Chapter
71. Fresh Osteochondral Total Ankle Allograft Transplantation For The Treatment Of Ankle Arthritis. Foot & Ankle International. (2008)
72. Operative Management Of Ankle Instability: Reconstruction With Open & Percutaneous Methods. Foot & Ankle Clinics. (2006)
73. Ankle & Hindfoot Reconstruction: What Is New In Ankle Arthroplasty, Allograft, & Fusion. Current Opinion In Orthopaedics. (2004)
