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The pain and stiffness you feel in your ankle could be arthritis. If left untreated, this nagging pain can get worse over time, eventually making it difficult to walk even short distances. Severe arthritis can restrict your mobility, but with proper treatment, you can minimize the pain and maximize your quality of life.

Arthritis is a broad term for a number of conditions that destroy the workings of a normal joint.. Almost half of people in their 60s and 70s have arthritis of the foot and/or ankle, but not all of them have symptoms.

Diagnosis

Typically, patients have stiffness or pain while walking. X-rays will show a decrease in the joint space in the ankle. 

Conservative Treatment

  • Stay fit
  • Low-impact exercise
  • Daily anti-inflammatory medications (NSAIDs)
  • Steroid injections (up to once every four month), for as long as they work

Surgery

  • Arthroscopic joint clean-up: typically if only bone spurs
  • Supra-malleolar osteotomy (if the joint is tilted and the other half of the ankle is healthy)
  • Ankle fusion
  • Ankle replacement

Ankle fusion

Traditionally, an ankle fusion has been used for severe ankle arthritis when non-operative treatments have failed. While a fusion provides reliable pain relief and improved function, the patient still struggles with immobilization of the joint, compromised function, and even accelerated degeneration of adjacent joints.

Recovery

Surgery takes about two hours and you stay overnight in the hospital. You will be placed into a cast for 6 weeks (cast change and suture removal at 2 weeks). Then you will be placed in a CAM boot for 6 more weeks. Four of those weeks you cannot walk on the ankle.

Ankle replacement

A total ankle replacement (or arthroplasty) is a treatment option for painful ankle arthritis, where the surfaces of the ankle joint are replaced by a prosthetic device consisting of metal and specialized orthopedic plastic (known as polyethylene). It is a similar procedure to joint replacements of the hip and knee, which have been helping to relieve pain and suffering in patients for over 60 years.

An ankle joint replacement cures the problem of arthritis in the ankle but does not sacrifice motion. Maintaining ankle motion with replacement surgery allows a more normal walking pattern, and prevents the wearing out of other joints in the foot that can occur after an ankle joint fusion.

Recovery

Surgery takes about two hours and you stay overnight in the hospital. You will be placed into a cast for 2 weeks.  Then you will be placed in a CAM boot for 4 more weeks. You start physical therapy in regular shoes at 6 weeks. 

Ankle fusion

Pros

Cons

Equal pain relief to replacement

12 weeks non weightbearing

Can correct severe deformities

Other ankle/foot joints deteriorate faster

Reliable and lasts forever

Bone may not fuse together and repeat surgery may need to be performed

Can perform in patients with neuropathy

Stiff ankle

 

Ankle replacement

Pros

Cons

Equal pain relief to fusion

Cannot perform in patients with neuropathy

Keeps ankle motion

75% survivorship at 10 years (revision surgery may be needed)

Only 2 weeks of nonweightbearing

Not as reliable in patients with severe deformities

Faster and easier walking

Not a great option for young patients

Decreases other joints from wearing out

30% of patients need some other procedure to maintain their ankle replacement

  • American Academy of Orthopaedic Surgeons
  • Arthroscopy Association of North America
  • American Orthopaedic Association
  • South Carolina Orthopedic Association