What is ankle arthritis?
The majority of joints in the body are lined by hyaline cartilage, a specialised tissue which allows for low friction articulation. Damage to this smooth lining can lead to arthritis or inflammation of the joint. The ankle joint transmits the load from the weight of the body to the many small joints of the foot. It is predominantly responsible for the up and down movement of the foot. Unlike the hip and knee which are usually affected by primary osteoarthritis (physiological wear and tear of the articular cartilage over time), the most common cause of ankle arthritis or inflammation of the tibiotalar joint is after trauma or repetitive injury, such as from an ankle or tibial plafond fracture, or chronic ankle ligament instability.
What are the symptoms of ankle arthritis?
Patients with symptomatic ankle arthritis typically describe pain and stiffness of their ankle which is worse on startup, aggravated after prolonged walking especially on uneven ground or physical activity, and associated with swelling. Their ankle may also feel worse in cold weather and better after they have warmed up. In contrast, patients with early or limited arthritis may complain of pain which is specifically brought on with certain movements, such as dorsiflexing or pulling their ankle up due to impingement from bone spurs (osteophytes) at the front of their ankle joint. With progression of the disease, deformity of their ankle and hindfoot may develop and worsen their limp.
How can ankle arthritis be managed?
Non-operative strategies for managing ankle arthritis include wearing ankle-high or rocker sole supportive shoes, using an ankle brace, losing and maintaining a healthy weight, activity modification by avoiding activities which aggravate your symptoms and by preferencing low impact-loading activities for exercise/recreation in the long term, such as swimming, cycling and Pilates, simple over-the-counter oral analgesia and/or oral/topical anti-inflammatory medication if not contraindicated as required, and/or an ultrasound-guided intra-articular corticosteroid and local anaesthetic injection to the ankle joint. Patients may similarly benefit from physical therapy or prehabilitation focusing on ankle and foot range of motion and stretching exercises, and general conditioning and strengthening of their lower limbs to optimise their pre-operative baseline, including exercising in the swimming pool or doing hydrotherapy.
What are the surgical treatment options for ankle arthritis?
What is the recovery after an ankle arthrodesis?
After your ankle joint fusion, you will be non-weight-bearing through your operated ankle for 8 weeks, and can then gradually progress from partial to full weight-bearing over another 8 weeks. You will be immobilised in a below-knee plaster backslab/fibreglass cast for 8 weeks, and can then transition to a CAM boot which you will only need to wear when you are ambulating for a further 8 weeks. It can take 3–4 weeks for your wounds to heal, 6–7 months for your ankle joint fusion to unite, 7–8 months before you are reasonably comfortable walking in normal supportive shoes, and at least 12 months for the swelling in your ankle to subside and for full recovery to your new baseline level.
What restrictions will I have after fusion of my ankle joint?
Following an ankle arthrodesis, you will theoretically lose the majority of the up and down movement of your foot and may notice a change in your gait, especially when you try to walk faster. However, this is usually well tolerated and not functionally noticeable, as patients with an arthritic ankle typically have limited movement of their tibiotalar joint already. In most cases, patients are generally able to return to their pre-operative occupation and activities. The screws and plate used to fix your ankle arthrodesis do not need to be removed unless it causes a problem.