Managing the effects of ankle arthritis

When people think of arthritis, affected body parts that typically come to mind are the knee, the hip, and maybe the lower back. But the fact is that wherever there are joints in the body, they are susceptible to the condition — including the ankles.

“As in other joints, ankle arthritis is a progressive disease where the cartilage has worn away, and the bones grind with weight bearing or motion,” says Dr. Justin Greisberg, an orthopedic foot and ankle specialist with NewYork-Presbyterian/Columbia University Irving Medical Center. “Hip or knee arthritis often happens from wear and tear over time. By contrast, ankle arthritis is almost never from normal wear. Its most common cause is post-traumatic, typically from an ankle fracture that may have occurred 20 years ago, or just two years ago. Ankle arthritis can also set in after a series of severe ankle sprains.”

Pain is typically felt in the lower shin, back of the foot, or middle of the foot. The pain can vary in intensity and frequency. It may be aching and dull or sharp and intense; it can come and go, or it can be a steady and chronic low level of pain with occasional flare-ups of more intense pain. There can be swelling and bone friction that makes the ankle stiff and less flexible, or a patient may hear a crunching or popping sound when pointing or flexing the toes, a sign that cartilage has worn away.

Managing the symptoms and the pain

Physicians must eliminate other conditions before making an ankle arthritis diagnosis. “With the right treatment regime, the degeneration can usually be slowed and pain controlled. Treating ankle arthritis is more than just relieving pain; it is restoring function, health, and vitality to a person,” says Dr. Greisberg. Some lifestyle changes can make a big difference, including:

Compresses: Using a warming pad or whirlpool for a few minutes can loosen a stiff ankle joint, making activity easier. Icing the ankle joint for 15 or 20 minutes after activity can decrease swelling and provide some immediate pain relief.

Change the workout routine: Engage in activities that put less stress on the ankles — try lower impact options, such as an exercise bike or swimming. Also, a physical therapist can give the patient specific exercises to stretch the ankle joint’s soft-tissues and build surrounding muscles.

Wear supportive footwear: Wear shoes that provide good support and discourage ankle “rolling” that causes a foot to turn in or out. High heels and flip-flops should be avoided. High top shoes and boots may help stabilize the ankle. Cushioning shoe inserts and orthopedic products such as walking canes and ankle braces can help stabilize the foot. Most drug stores sell an elastic ankle sleeve, which can be worn during the day to decrease swelling. An orthopedic ankle specialist can prescribe a lace-up brace for more support.

Lose weight: Shedding even 10 pounds of extra body weight will almost certainly make the ankle feel less sore, exerting less pressure on the joints.

Medication:  As long as your primary care doctor says it is okay, anti-inflammatory medications can be helpful. Rather than every day, it might be safer to use medication an hour before an exercise session.

If symptoms persist and lifestyle changes have no effect, medical interventions are usually the next step. Says Dr. Greisberg, “Injections can be of some value, especially when looking for short-term pain relief. In the most severe cases, surgery can be considered. Some patients will be candidates for smaller bone spur shaving procedures. Ankle fusions have been successful for decades, and ankle replacements, with an artificial joint, can be extremely effective at both relieving pain and restoring motion. Says Dr. Greisberg, “Ankle replacements have come a long way in the past 20 years. The procedure can be a real home run for the right patient.”