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Osteoarthritis and Posttraumatic Arthritis of the Ankle

Reviewed by
Dr. Patrick DeHeer

Osteoarthritis, also known as “wear and tear” arthritis, is a very common disorder affecting the joints. Our joints are protected by a cushion of articular cartilage that allows the bones to glide over one another at the points where they meet.

Osteoarthritis occurs when this cartilage breaks down and erodes over time. This allows the adjacent bones of a certain joint to rub directly against one another, causing pain, inflammation, and swelling.

This wearing away of the cartilage can also be caused or exacerbated by trauma, in which case it is known as posttraumatic arthritis.

Osteoarthritis is more common in older people than in younger people—as we age, osteoarthritis can be brought on by years of use, microtrauma, or structural biomechanical deformities or malalignments that place abnormally large amounts of pressure on a specific area of the joint.

While its incidence among younger people is about equal for men and women, women over the age of 55 are far more likely to suffer from osteoarthritis than men of the same age.

While the disease affects the knees and hips more often than it affects other joints, ankle osteoarthritis is not unusual, particularly among ballet dancers and among athletes who use their ankles in a similar fashion.

Ankle Osteoarthritis Symptoms to Watch For

Symptoms of osteoarthritis tend to appear in late middle age, and most people have at least some of these symptoms by the age of 70.

These symptoms include pain with walking or any motion of the joint, stiffness, muscle atrophy as a result of decreased motion of the joint, and crepitus (cracking sound with movement of the joint caused by bone-to-bone contact).

When osteoarthritis of the ankle first begins to occur, the pain is usually present only at times of increased activity—for example, when running, playing basketball, etc.

Usually the joint will be stiff and painful at first, but then it will “loosen up” as the activity progresses. After the activity stops, however, the pain returns, and it is often quite severe. Over time, as the articular cartilage continues to erode, the pain begins to appear even when at rest.

While this is true of most forms of osteoarthritis, osteoarthritis of the ankle in particular is characterized by a narrowing of the joint space and by ankle impingement caused by the formation of bone spurs around the joint.

What Causes Ankle Osteoarthritis?

As we age, our articular cartilage begins to lose its ability to regenerate and repair itself. Therefore, the cartilage begins to wear away with damage.

When this happens, we lose the protection afforded us by the slippery, rubbery texture of the cartilage, and eventually the bones begin to rub against one another when we move.

Over time, this weakens the ligaments surrounding the joint, causing them to become stiffer. The erosion of the cartilage also makes the joint more vulnerable to injury, which increases the risk of posttraumatic arthritis.

What are the Risk Factors for Ankle Osteoarthritis?

While ankle osteoarthritis can happen to anyone, certain risk factors increase your likelihood of acquiring it:

  • Heredity—osteoarthritis often runs in families, especially if structural deformities are present in the feet that place abnormal loads on certain areas of cartilage.
  • Obesity—carrying extra body weight puts unnecessary strain on the joints, particularly the knees and ankles.
  • Athletic activity: Sports that involve sudden, rapid turning, such as basketball or soccer, can increase wear and tear on the ankle joint. Football players often suffer impact-related injuries to their ankles, which can lead to posttraumatic osteoarthritis later in life. (For more information about this subject, see our article about dangerous sports for your feet and ankles.)
  • Occupations that require the worker to kneel or squat for prolonged periods can put a great deal of strain on the joints.

What Are the Complications of Ankle Osteoarthritis?

Over time, untreated ankle osteoarthritis can degrade the quality of life for those who suffer from it. Everyday tasks can become difficult, and walking may become so painful as to confine the affected person to a wheelchair.

How is Ankle Osteoarthritis Diagnosed?

If you begin to suffer symptoms of ankle osteoarthritis, you should have yourself examined by a podiatric physician. Your doctor will want to take x-rays of your ankle and may even recommend other imaging tests, such as an MRI or CT scan.

If you do have osteoarthritis, these imaging tests will probably show a loss of joint space (i.e., a narrowing of the space between the bones due to loss of cartilage), wearing away of the ends of the bones, and possibly the formation of bone spurs and cysts.

A physical examination will show an enlarged, painful, and swollen joint with limited motion and possibly crepitus (crackling sound with joint movement)

Blood tests may also be helpful in ruling out other causes of pain, such as rheumatoid arthritis, an autoimmune disease that causes the immune system to attack the body’s own joint cartilage.

In some cases, your doctor may wish to obtain a sample of your joint fluid to rule out the possibility that your symptoms are being caused by gout or a form of bacterial infection known as septic arthritis.

Other causes of joint pain that your doctor will need to rule out may include psoriatic arthritis, Reiter’s syndrome, Lyme disease, lupus, Crohn’s disease, ulcerative colitis, ankylosing spondylitis, viral or fungal arthritis, scleroderma, and dermatomyositis.

How is Ankle Osteoarthritis Treated?

Osteoarthritis is a very difficult condition to treat. Conservative therapy involves pain relief, decreasing inflammation, and immobilizing the affected joint.

Treatments include pain management with acetaminophen (Tylenol), or with NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen (e.g., Motrin, Advil, etc.). Heat or cold packs can also provide some relief from the pain.

Your doctor may suggest an exercise routine that emphasizes water activities such as swimming, and if you are overweight you will be advised to adopt a healthier lifestyle.

Other treatments include chondroitin sulfate, glucosamine, steroid injections, specialized shoes to decrease ankle motion during walking, orthotics, range-of-motion exercises to help decrease stiffness, and ankle braces to immobilize the painful joint.

You may also be a candidate for synovial fluid viscosupplements, which are joint injections to cushion and lubricate the joint space.

The most severe cases of ankle osteoarthritis will require surgical intervention. The most common surgeries for this condition are arthroscopic ankle surgery, open ankle fusion, ankle implant, or arthrodiastasis (ankle joint stretched for six to twelve weeks nonstop to allow cartilage a chance to regrow).

Medical References:

    National Institutes of Health NYU Langone Medical Center The Mayo Clinic The Arthritis Foundation The American College of Rheumatology Centers for Disease Control and Prevention The American Academy of Orthopaedic Surgeons Houston Methodist Orthopedics & Sports Medicine

This page was last updated on October 1st, 2015

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