Anatomy

During standing, walking, and running, the foot and ankle provide support, shock absorption, balance, and information on movement essential for motion. Three bones make up the ankle joint, primarily enabling up and down movement. There are 28 bones in the foot, and more than 30 joints that allow for a wide range of movement.

In many of these joints the ends of the bones are covered with articular cartilage—a slippery substance that helps the bones glide smoothly over each other during movement. Joints are surrounded by a thin lining called the synovium. The synovium produces a fluid that lubricates the cartilage and reduces friction.

Description

The major types of arthritis that affect the foot and ankle are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

  1. Osteoarthritis
    Osteoarthritis is a degenerative type of arthritis that occurs most often in people 50 years of age and older, though it may occur in younger people as well.

    In osteoarthritis, the cartilage in the hip joint gradually wears away over time. As the cartilage wears away, it becomes frayed and rough, and the protective joint space between the bones decreases. This can result in bone rubbing on bone. To make up for the lost cartilage, the damaged bones may start to grow outward and form bone spurs (osteophytes). The loss of cartilage also reduces the natural joint fluid that lubricates the joint.

    Osteoarthritis develops slowly. Some times osteoarthritis can be exacerbated for days to weeks at a time and then decrease, especially after an injury. The natural course of osteoarthritis is chronic with worsening join and pain over time without therapy.

  2. Rheumatoid ArthritisRheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body, and often starts in the foot and ankle. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

    Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium covering the joint, causing it to swell. Over time, the synovium invades and damages the bone and cartilage, as well as ligaments and tendons, and may cause serious joint deformity and disability.

  3. Posttraumatic Arthritis
    Posttraumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away. It can develop many years after the initial injury.
Symptoms

The most common symptom of ankle osteoarthritis is pain around the ankle joint. Usually, the pain develops slowly and worsens over time, although sudden onset is also possible. Pain and stiffness may be worse in the morning, or after sitting or resting for a while. Over time, painful symptoms may occur more frequently, including during rest or at night.

Additional symptoms may include:

  • Pain that flares up with vigorous activity
  • Joint swelling and warmth
  • “Locking” or “sticking” of the joint called stiffness
  • Grinding noise (crepitus) during movement caused by loose fragments of cartilage and other tissue interfering with the smooth motion of the ankle
  • Decreased range of motion in the hip that affects the ability to walk and may cause a limp

Location of Ankle Arthritis

  • Ankle Joint – the ankle joint is made up of the tibia and talus, but also includes the fibula. Its main function is to dorsiflex and plantarflex.
  • Subtalar Joint – the subtalar joint is comprised of the plantar surface of the talus and the superior or dorsal surface of the calcaneus. There are three main facets: anterior, middle and posterior, with the posterior facet accounting for the majority of the cross sectional area of the joint.
Treatment

There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.

Nonsurgical Treatment
Lifestyle modifications. Some changes in your daily life can help relieve the pain of arthritis and slow the progression of the disease. These changes include:

  • Minimize activity that aggravates the pain
  • Switching from high impact activity like running and jumping to lower impact activity such as swimming or cycling
  • Weight loss
  • Physiotherapy – can help improve range of motion and relieve stress on the joint.
  • Braces
    • Ankle-foot orthosis (gauntlet leather brace)
    • Hinged AFO
    • Custom made shoes with stiff soles and rocker bottoms
    • Custom orthotics
  • Medications
    • Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
    • Topical anti-inflammatories
      • Compound Topical Creams
      • Voltaren
    • Injections
      • Steroid (Depo-Medrol, Kenalog, Decadron)
      • Viscosupplement
      • Blood (PRP – Platelet Rich Plasma)

Surgical Treatment
Your doctor may recommend surgery if your pain causes disability and is not relieved with nonsurgical treatment. The type of surgery will depend on the type and location of the arthritis and the impact of the disease on your joints. In some cases, your doctor may recommend more than one type of surgery.

  • Arthroscopic debridement. This surgery may be helpful in the early stages of arthritis. Debridement (cleansing) is a procedure to remove loose cartilage, inflamed synovial tissue, and bone spurs from around the joint.
  • Arthrodesis (fusion). Arthrodesis fuses the bones of the joint completely, making one continuous bone out of two or more bones. The goal of the procedure is to reduce pain by eliminating motion in the arthritic joint.

In most cases, surgery relieves the pain of arthritis and makes it easier to perform daily activities. Full recovery can take from 4 to 9 months, depending on the severity of your condition before surgery and the complexity of your procedure. Foot and ankle surgery can be painful. While you should expect to feel some discomfort, advancements in pain control now make it easier for your doctor to manage and relieve pain. Immediately after surgery, you will be given medication for pain relief. If needed, your doctor will provide you with a pain reliever that you can take for a short time while you are home. Physiotherapy after the procedure will be necessary to relearn walking and strengthening associated muscles.