Arthritis of the upper ankle. Diagnostics & Therapy
What are the treatment options for arthritis of the ankle?
Pain when walking or at rest, increasing restriction of movement and signs of inflammation in the joint are typical signs of osteoarthritis of the ankle. What kind of treatment helps best, depends primarily on the stage of osteoarthritis and the degree of discomfort that occurs.
There have been major recent advances in the treatment of upper ankle arthritis. While stiffening of the ankle (arthrodesis) was previously the only choice in terms of treatment, nowadays there are treatment options which depend on the stage of the disease, many of which allow joint mobility to be maintained.
Conservative treatment for arthritis of the upper ankle.
In the early stages of the disease, which are characterised by reduced upper ankle mobility, conservative treatment will often result in the significant alleviation of symptoms. The principle in these cases is to transfer the rolling motion in the ankle to the sole of the shoe. This is accomplished using a rounded sole (rolling sole). Various manufacturers nowadays offer shoes with a rounded sole. Alternatively, ready-made shoes from orthopaedic shoe manufacturers can be modified by adding a rounded sole. Even more stability os offered by shoes which grip the ankle and support it on the outside. Both concepts significantly limit the choice of shoes, as a result of which these approaches to treatment do not meet with much approval, especially among women.
If x-rays still show a good joint space but large bone spurs which impair mobility, there is the option of removing these bone spurs in an arthroscopic procedure. This involves inserting a small camera into the joint through two small incisions on the inner and outer sides of the ankle. The surgical instruments are introduced through the second incision. In this manner, even relatively large bone spurs can be removed using a minimally invasive technique. In most cases, this procedure can achieve significant relief of the symptoms, even if the arthritis cannot be completely cured.
Cartilage reconstruction procedures
Cartilage reconstruction procedures have established themselves in recent years. This involves cartilage cells being taken from the ankle, cultured in a laboratory and then re-implanted into the joint. Alternatively, membranes are used that are supposed to promote the growth of cartilage cells. Various studies have shown that these procedures deliver good results, particularly in cases of localised cartilage damage on the talus bone. If the arthritis is diffuse throughout the entire joint and involves extensive cartilage damage, these procedures are not suitable.
Artificial ankle joint.
Similar to knees and hips, there is now the option of replacing the upper ankle with an endoprosthesis. This has the major advantage of allowing joint mobility to maintained. While the first models of these prostheses in the seventies and eighties were not convincing, the latest products offer ten year prosthesis survival rates of 85-90 %. While these results are not as good as those after hip replacement, a prosthesis can in many cases be replaced after it loosens.
If this is not possible, ankle arthrodesis will be performed. This would in any case have been the other alternative to a prosthesis. After ankle replacement, the patient's shoe choice is not significantly restricted. Sporting activities such as cycling, swimming, hiking or even alpine skiing are possible in most cases. It is recommended that patients avoid high-impact sports such as jogging, tennis or squash.
Stiffening of the ankle (arthrodesis)
In an arthrodesis surgery, the damaged cartilage is removed from the joint and the talus is affixed to the shin bone (tibia) using screws. It takes between 6 and 12 weeks before both bones have grown together and are stable. The advantage of this procedure is that there are almost no limitations on the mechanical strength of the ankle and the patient is not faced with the risk of a prosthesis becoming loose.
However, stiffening the ankle joint does result in a visible change in the patient's gait. Long-term analyses have shown that the lack of mobility in the ankle results in significantly increased stress on the knee, hip, spine and midfoot. In one study, excessive stress reactions of greater or lesser severity were observed in these joints in almost 80 % of patients 10 years after ankle arthrodesis.
With the exception of arthrodesis, follow-up care for all other procedures is focussed on maintaining mobility with the appropriate physiotherapeutic exercises. The scope and intensity of the exercises must be agreed on a case-by-case basis depending on the extent of the joint damage and the treatment administered. Inpatient follow-up rehabilitation is an option after endoprosthetic ankle replacement surgery. Ankle arthrodesis requires the joint being immobilised for 12 weeks; it is recommended that no weight at all be put on the ankle for the first 6 weeks.
Arthritis of the upper ankle
Similar to arthritis in the knee and hip, arthritis in the upper ankle results in significantly reduced leg function.
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