Ankle Joint Arthritis

Ankle arthritis leads to pain and swelling in the ankle joint. Symptoms are often aggravated by standing and walking and patients often walk with a limp. Ankle arthritis commonly results from a history of trauma to the ankle, either a severe ankle injury such as a bad ankle fracture, or a series of recurrent injuries to the ankle. However, it may develop from other causes such as uneven loading of the ankle joint due to an alignment deformity; inflammatory arthritis such as rheumatoid arthritis; crystal arthritis such as gout, or secondary to a serious joint infection. Patients with severe ankle arthritis will often have limited ankle motion and may have a grinding sound when they move their ankle joint. Ankle arthritis is commonly associated with loss of cartilage from the ankle joint which will show up on a weight-bearing ankle x-ray.

There is non-operative and operative treatment for ankle arthritis. The goals of treatment are to minimize pain and discomfort and improve function. The type of treatment will depend on your symptoms and the extent of the ankle arthritis. Often non- operative treatment can be successful in significantly decreasing symptoms. Many of the non-operative treatment approaches can also be helpful in conjunction with surgery.

Non-Operative Treatment

There are a variety of non-operative treatments. These treatments are designed to:

1. Limit the force going through the ankle joint;

2. Limit the movement through the ankle joint and/or;

3. Minimize the pain response.

At Podiatry clinics we have many years experience in providing none operative care for patients with ankle arthritis and those who have had a surgical ankle fusion. After assessment we may provide you with Rocker bottomed footwear specially designed to your individual needs. We have developed a specialist expertise in managing severely restricted ankle joint motion via modified rocker soled shoes. This will often be combined with functional foot orthoses and rehabilitative exercise advice. When appropriate, therapeutic steroid injections may also be offered.

CorticoSteroid injections

Corticosteroid injections cause a non-specific dampening of the inflammatory response produced by inflamed or arthritic joints and tissues, potentially providing short term pain relief. While such injections are not a permanent solution, since the underlying condition causing the inflammation remains unchanged, treatment of the symptoms enable patients to break the cycle of immobilisation long enough to have the potential to restore range of motion and build strength in order to improve function in the long term.

What are Corticosteroids?

Corticosteroids are a class of steroid hormone produced in the adrenal gland. Cortisone, a common natural hormone, is a type of corticosteroid.

When are Corticosteroid injections indicated?

Injection of a corticosteroid, like cortisone, into an inflamed or arthritic joint or an inflamed area of tissue such as a tendon or nerve may provide some short – or intermediate-term pain relief. This pain relief occurs by settling down the body’s inflammation response, thereby decreasing the pain response (less inflammation often correlates with less pain). The decrease in inflammation and pain will ideally lead to improved function.

Often, the steroid is injected with a local anaesthetic like lidocaine to provided short-term numbing of the area. The anaesthetic typically wears off within a few hours. This is why it is common for patients to experience worsening symptoms over the next few days before noting improvement. Injections are relatively easy to administer, take effect more rapidly than traditional anti-inflammatory medications, and avoid side effects that often accompany them like stomach irritation.

Cortisone injection has variable levels of effectiveness. Some patients enjoy successful results for up a number of months while others may see entirely no change. Injections are typically limited to 2-3 per year. Routine regular injections should probably be avoided if possible because each injection tends to weaken the tissue. Minimising the inflammatory response (which is what the injections do) tends to inhibit the natural healing process. Over time, the effectiveness of the injections may diminish. Therefore, more injections do not necessarily result in greater benefits.

Are there any side effects?

Side-effects are very unlikely but occasionally you may notice a flare-up of joint pain within the first 24 hours after the injection. This usually settles on its own within a couple of days.

Very rarely you may get an infection in the joint at the time of an injection. If your joint becomes more painful and hot you should see your doctor immediately, especially if you feel unwell.

Injections can occasionally cause some thinning or changes in the colour of your skin at the injection site, particularly with stronger preparations. In very rare cases a steroid injection into the muscle can lead to an indentation in your skin around the area.

Local steroid injections may sometimes cause facial flushing or interfere with the menstrual cycle. Other steroid-related side-effects are rare unless you have frequent injections (more than a few times per year).

Any treatment with steroids may cause changes in your mood – you may feel very high or very low. This may be more common if you have a previous history of mood disturbance.

Midfoot Arthritis

Midfoot arthritis is due to two differing problems. The first is due to trauma or sprain of the midfoot (Lisfranc Joint) which results in a partial dislocation of the midfoot and arthritis over time. The second common cause is degeneration or loss of cartilage in the midfoot due to abnormal wear and tear or looseness of the midfoot and chronic abnormal motion.

The midfoot consists of a series of many small complex joints. An unstable foot can result in excessive compressional stresses on these joints with subsequent pain. If the problem is not controlled then pain can develop to the extent that arthritis forms, which is more challenging to manage. In most instances patients with midfoot pain require good mechanical control having first been mechanically and gait analysed. A rigid or semi-rigid orthotic is often essential to buffer and support the joints.

Common treatments of arthritis include physical therapy, functional foot orthoses and bracing care to limit abnormal motion and possibly injection therapy. In most cases a period of relief may be available with conservative care. However, the arthritic process will continue to get worse and, in some cases, surgical correction is required this will require onward referral to a suitable podiatric or orthopaedic surgeon.