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Ankle Osteoarthritis

What is Ankle Osteoarthritis?

Ankle osteoarthritis (OA) is a relatively common condition that affects the cartilage, a smooth, flexible tissue that cushions the ends of bones in the knee joint. Over time, the cartilage in the ankle joint can wear down and become rough, leading to pain, stiffness, inflammation and loss of function in the knee.

Who is affected by ankle osteoarthritis?

Ankle osteoarthritis is most common in adults over the age of 50, and the risk of developing it increases with age. Women are more likely than men to develop ankle osteoarthritis, especially after menopause. Other factors that increase the risk of ankle osteoarthritis include:

  • Obesity:

    Excess weight puts extra stress on the ankle joint.

  • Previous ankle injuries:

    Injuries to the ankle, such as combined bone and cartilage (osteochondral) injuries, ligament rupture, fractures or dislocations, can increase the risk of developing osteoarthritis later in life.

  • Family history:

    Having a family history of osteoarthritis increases your risk of developing it yourself.

What are the main symptoms of ankle osteoarthritis?

 

The main symptoms of ankle osteoarthritis include:

  • Pain: Pain in the ankle, especially when walking, climbing stairs, or getting in and out of chairs.
  • Stiffness: Stiffness in the ankle, especially in the morning or after periods of inactivity.
  • Loss of range of motion: Difficulty bending or straightening the ankle fully.
  • Creaking or popping sounds: Crepitus, or grating or clicking sounds, when moving the ankle and particularly when walking up and down stairs, and with squats or lunges.

Symptoms may worsen gradually over time and may fluctuate depending on the level of activity. Activities that involve weight-bearing, such as walking, climbing stairs, or standing for long periods, can aggravate the pain and discomfort.

How is ankle osteoarthritis diagnosed?

Diagnosis of ankle osteoarthritis typically involves a physical examination, medical history review, and imaging tests.

  • Physical examination:

    The doctor will carefully examine the ankle, checking for pain, tenderness, range of motion limitations, crepitus, and swelling. Specific tests may be performed to assess the severity of the osteoarthritis and rule out other causes of ankle pain.

  • Medical history:

    The doctor will inquire about the patient's symptoms, activities, any previous ankle injuries, and family history of osteoarthritis.

  • Imaging tests:

    X-rays are often used to visualize the bones in the ankle joint, identifying any narrowing of the joint space, osteophytes (bone spurs), or other signs of osteoarthritis. An MRI scan may be recommended to provide more detailed images of the soft tissues, including the cartilage, in the ankle joint. An ultrasound can be a useful way of assessing for an effusion (fluid in the ankle).

How is ankle osteoarthritis treated?

 

Treatment for ankle osteoarthritis focuses on managing symptoms, slowing the progression of the condition, and improving function. Non-surgical treatments are usually tried first, and surgery is considered if non-surgical measures fail to provide adequate relief.

Non-surgical treatments:

  • Weight management:

    Losing weight can help reduce stress on the knee joint and alleviate pain.

  • Exercise:

    Low-impact exercises, such as walking, swimming, or water aerobics, can help improve range of motion, strengthen the muscles around the ankle, and reduce pain.

  • Over-the-counter pain relievers:

    Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate mild to moderate pain and inflammation.

  • Physiotherapy:

    Physiotherapy can provide exercises and stretches to improve range of motion, strengthen the muscles around the ankle, optimise balance and promote normal ankle movement patterns.

  • Assistive devices:

    Using assistive devices, such as a frame or stick, can help reduce stress on the ankle joint and alleviate pain.
  • Corticosteroid injections can be an effective way of reducing inflammation and pain in the ankle joint. At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, where the risk and benefits of the procedure are discussed in detail with your doctor. The experienced medical doctor will then place you in a lying position with the foot flat on the bed. The skin is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions. The ankle joint injection is performed with a small dose of steroid and local anaesthetic, targeting the front (anterior) aspect of the joint.

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given. The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever. If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed. The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours). This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

Surgical treatments:

If non-surgical treatments fail to provide adequate relief, surgery may be considered.

Surgery is typically considered for patients with severe ankle osteoarthritis that significantly impacts their quality of life and limits their ability to perform daily activities, who have failed conservative management.

Additional tips for managing ankle osteoarthritis pain:

  • Avoid activities that aggravate the pain, such as high-impact exercises or running.
  • Pace yourself and take breaks when necessary.
  • Use assistive devices if needed.
  • Maintain a healthy weight to reduce stress on the knee joint.