Ankle
What is Ankle Arthritis?
Arthritis is a
condition which affects joints in the body. The surface of
the joint is damaged and the surrounding bone grows
thicker.
To understand how arthritis develops, you
need to know how a normal joint works. A joint is where
two bones meet. The ends of the bones are covered by a
thin layer of gristle called cartilage. This cartilage
cushions the joint and spreads the forces evenly when you
put pressure on the joint. The smooth, slippery cartilage
surface also allows the bone ends to move freely. When a
joint develops arthritis, the cartilage gradually roughens
and becomes thin, and the bone underneath thickens or
erodes.
What causes Ankle arthritis?
There are three types of arthritis that may affect your
ankle.
Osteoarthritis
Osteoarthritis, also known as degenerative or "wear and
tear" arthritis, is a common problem for many people after
they reach middle age. Over the years, the smooth, gliding
surface covering the ends of bones (cartilage) becomes
worn and frayed. This results in inflammation, swelling,
and pain in the joint. Osteoarthritis progresses slowly
and the pain and stiffness it causes worsens over time.
Rheumatoid Arthritis
Unlike osteoarthritis which follows a predictable
pattern in certain joints, rheumatoid arthritis is a
system-wide disease. It is an inflammatory disease where
the patient's own immune system attacks and destroys
cartilage.
Post-Traumatic Arthritis
Post-traumatic arthritis can develop after an injury to
the foot or ankle. This type of arthritis is similar to
osteoarthritis and may develop years after a fracture,
severe sprain, or ligament injury.
What are the symptoms and signs of osteoarthritis?
Signs and symptoms of arthritis of the ankle vary,
depending on the stage of the arthritis. Common symptoms
include:
- Pain or tenderness
- Stiffness or reduced motion
- Swelling
- Difficulty walking due to any of the above
Achilles Tendon Disorders
Achilles tendonitis is an inflammation of the Achilles
tendon. This inflammation is typically short-lived. Over
time the condition usually progresses to a degeneration of
the tendon (Achilles tendonosis), in which the tendon
loses its organized structure and is likely to develop
microscopic tears. Sometimes the degeneration involves the
site where the Achilles tendon attaches to the heel bone.
In rare cases, chronic degeneration with or without pain
may result in rupture of the tendon.
As “overuse” disorders, Achilles tendonitis and
tendonosis are usually caused by a sudden increase of a
repetitive activity involving the Achilles tendon. Such
activity puts too much stress on the tendon too quickly,
leading to micro-injury of the tendon fibers. Due to this
ongoing stress on the tendon, the body is unable to repair
the injured tissue. The structure of the tendon is then
altered, resulting in continued pain.
Treatment approaches for Achilles tendonitis or
tendonosis are selected on the basis of how long the
injury has been present and the degree of damage to the
tendon. If non-surgical approaches fail to restore
the tendon to its normal condition, surgery may be
necessary. The foot and ankle surgeon will select the best
procedure to repair the tendon.
Ankle Fractures and Broken Ankles
A fracture is a partial or complete break in a bone. In
the ankle, fractures can range from the less serious
avulsion injuries (small pieces of bone that have been
pulled off) to severe shattering-type breaks of the tibia,
fibula or both. Following an ankle injury it is important
to have the ankle evaluated by a foot and ankle surgeon
for proper diagnosis and treatment. If you are unable to
do so right away, go to the emergency room and then follow
up with a foot and ankle surgeon as soon as possible for a
more thorough assessment.
Ankle Pain
Ankle pain is often due to an ankle
sprain but can also be caused by ankle instability, arthritis, gout, tendonitis, fracture, nerve compression (tarsal
tunnel syndrome), infection and poor structural
alignment of the leg or foot. Ankle pain can be associated
with swelling, stiffness, redness, and warmth in the
involved area. The pain is often described as an intense
dull ache that occurs upon weight bearing and ankle
motion. Initial treatment may consist of rest, ice,
elevation, and immobilization, but may also include
nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen, physical therapy, and cortisone injection. A
foot and ankle surgeon can best determine the cause of the
ankle pain and appropriate treatment options.
Ankle Sprain
An ankle sprain is an injury to one or more ligaments
in the ankle, usually on the outside of the ankle.
Ligaments are bands of tissue—like rubber bands—that
connect one bone to another and bind the joints together.
In the ankle joint, ligaments provide stability by
limiting side-to-side movement. The severity of an ankle
sprain depends on whether the ligament is stretched,
partially torn, or completely torn, as well as on the
number of ligaments involved. Sprained ankles often result
from a fall, a sudden twist, or a blow that forces the
ankle joint out of its normal position. Ankle sprains
commonly occur while participating in sports, wearing
inappropriate shoes, or walking or running on an uneven
surface.
When you have an ankle sprain, rehabilitation is
crucial—and it starts the moment your treatment begins.
Your foot and ankle surgeon may recommend physiotherapy.
In more severe cases, surgery may be required to
adequately treat an ankle sprain. Surgery often involves
repairing the damaged ligament or ligaments. The foot and
ankle surgeon will select the surgical procedure best
suited for your case based on the type and severity of
your injury as well as your activity level.
After surgery, rehabilitation is extremely important.
Completing your rehabilitation program is crucial to a
successful outcome. Be sure to continue to see your foot
and ankle surgeon during this period to ensure that your
ankle heals properly and function is restored.
Peroneal Tendon Injuries
In the foot, there are two peroneal tendons. They run
side-by-side behind the outer ankle bone. The main
function of the peroneal tendons is to stabilize the foot
and ankle and protect them from sprains.
Peroneal tendon injuries may be acute (occurring
suddenly) or chronic (developing over a period of time).
They most commonly occur in individuals who participate in
sports that involve repetitive ankle motion. In addition,
people with higher arches are at risk for developing
peroneal tendon injuries.
Chronic Ankle Instability
Chronic ankle instability is a condition characterized
by a recurring “giving way” of the outer (lateral) side of
the ankle. This condition often develops after repeated ankle sprains. Usually the “giving way” occurs while
walking or doing other activities, but it can also happen
when you’re just standing. Many athletes, as well as
others, suffer from chronic ankle instability.
Chronic ankle instability usually develops following an
ankle sprain that has not adequately healed or was not
rehabilitated completely. Repeated ankle sprains often
cause—and perpetuate—chronic ankle instability. Having an
ankle that gives way increases your chances of spraining
your ankle repeatedly. Each subsequent sprain leads to
further weakening (or stretching) of the
ligaments—resulting in greater instability and the
likelihood of developing additional problems in the ankle.
In some cases, the foot and ankle surgeon will
recommend surgery based on the degree of instability or
lack of response to non-surgical approaches. Surgical
options mainly involve repair or reconstruction of the
damaged ligament(s). However, other soft tissue or bone
procedures may be necessary depending on the severity of
your condition and whether you have other problems in the
foot or ankle. The length of the recovery period will
vary, depending on the procedure or procedures performed.
Arthroscopic Surgery
Arthroscopy is a minimally invasive procedure that
allows surgeons to diagnose and treat joint injuries
through small incisions in the skin. It is often performed
to confirm a diagnosis made after a physical examination
and other imaging tests such as X-rays, MRI, CT scans.
During an arthroscopic procedure, a thin fiberoptic light,
are inserted into the problem area, allowing the doctor to
examine the joint in great detail.
For some patients it
is then possible to treat the problem using this key hole
surgery. Sports injuries are often repairable with
arthroscopy. Cartilage damage is repaired through the
arthroscope.
Because it is minimally invasive, arthroscopy offers
many benefits to the patient over traditional surgery.
There is no cutting of muscles or tendons. The smaller
incisions lead to minimal scarring. This lead to faster
recovery and return to regular activities
Arthroscopy
is not appropriate for every patient. Your doctor will
discuss the diagnostic and treatment options that are best
for you.
Total Ankle Replacement
Symptoms
The symptoms of a degenerative ankle joint usually
begin as pain while bearing weight on the affected ankle.
You may limp and the ankle may become swollen with fluid.
The degeneration can lead to a reduction in the range of
motion of the affected ankle. Bone spurs will usually
develop and can be seen on X-ray. Finally, as the
condition becomes worse, the pain may be present all the
time and may even keep you awake at night.
Diagnosis
The diagnosis of a degenerative ankle starts with a
complete history and physical examination by your doctor.
X-rays will be required to determine the extent of the
degenerative process and may suggest a cause for the
degeneration.
Ankle Replacement Surgery
In ankle replacement surgery, the damaged bone and
cartilage are replaced with metal and plastic surfaces
that are shaped to restore ankle movement and function.
The new artificial ankle is called a prosthesis. The
prosthesis is generally composed of two metal pieces
fitted onto the ends of the tibia (shin bone) and the
talus (heel bone) and a plastic piece inserted between
them to act as a bearing.
|
