Arthritis is inflammation resulting from the degeneration of cartilage in the joint causing pain, swelling, and stiffness in the joints resulting in restricted movements. Arthritis of the foot and ankle joint can occur due to fracture, dislocation, inflammatory disease, or congenital deformity. The foot joints most commonly affected by arthritis are:
- The joint between the shin bone (tibia) and ankle bone (talus)
- The three joints of the foot that include the heel bone, the inner mid-foot bone, and the outer mid-foot bone
- The joint of the great toe and foot bone
There are three types of arthritis affecting the foot and ankle and may include:
Osteoarthritis: Also, called degenerative joint disease, this is the most common type of Arthritis, which occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.
Rheumatoid Arthritis: This is an auto-immune disease in which the body’s immune system (the body’s way of fighting infection) attacks healthy joints, tissues, and organs. It can cause pain, stiffness, swelling, and loss of function in joints. Rheumatoid Arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (both feet) at the same time and with the same symptoms.
Post-traumatic arthritis: Arthritis developing following an injury to ankle or foot is called as post-traumatic arthritis. The condition may develop years after the trauma such as a fracture, severe sprain, or ligament tears.
Rheumatoid arthritis is often caused when the genes responsible for the disease is triggered by infection or any environmental factors. With this trigger body produce antibodies, the defence mechanism of body, against the joint and may cause rheumatoid arthritis. Fractures at joint surfaces and joint dislocations may predispose an individual to develop post-traumatic arthritis. It is considered that your body secretes certain hormones following injury which may cause death of the cartilage cells. Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.
Symptoms of foot and ankle arthritis include pain or tenderness, swelling, and stiffness in the joint and limited range of motion.
The diagnosis of foot and ankle arthritis is made with a medical history, physical examination and X-rays of the affected joint. A bone scan, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.
Nonsurgical treatment options for foot and ankle arthritis include medications (anti-inflammatories), injections (steroids), physical therapy, ankle-foot orthosis (AFO), weight loss, orthotics such as pads or arch supports, and canes or braces to support the joints. Surgery may be required to treat foot and ankle arthritis, if your symptoms do not get better with conservative treatments. Surgery performed for arthritis of the foot and ankle includes:
Arthroscopic surgery: Arthroscopy is a surgical procedure during which the internal structure of a joint is examined for diagnosis and treatment of problems inside the joint. In arthroscopic examination, a small incision is made in the patient’s skin through which pencil-sized instruments that have a small lens and lighting system (arthroscope) are passed. Arthroscope magnifies and illuminates the structures of the joint with the light that is transmitted through fibre optics. It is attached to a television camera and the interior of the joint is seen on the television monitor. Your surgeon can then use probes, forceps, knives, and shavers, to clean the joint area of foreign tissue, inflamed tissue, or bony outgrowths (spurs).
Arthroplasty or Joint Replacement: In this procedure, your surgeon removes the damaged ankle joint and replaces it with an artificial implant. It is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis or post-traumatic arthritis. The goal of ankle replacement is to relieve pain and restore the normal function of the ankle joint.
Ankle arthrodesis is the surgical fusion of bones that form the ankle joint. The ankle joint is formed by the tibia, talus, and the fibula bones.
The goal of ankle arthrodesis is to relieve pain in the affected joint. This is achieved by surgically eliminating the joint.
Ankle arthrodesis is recommended for the treatment of severe end stage arthritis that has not responded to conservative treatment measures such as medications or injections. The other indications include ankle infections, neurological ankle instability, and tumours.
Ankle conditions should be evaluated for proper diagnosis and treatment. Accurate diagnosis comprises of a detailed medical history and physical examination. Imaging tests such as X-rays, Doppler Test, and MRI may be ordered.
Ankle arthrodesis can be performed as an arthroscopic or open traditional surgery. The approach for an open technique can be either from anterior (front) aspect or lateral (side) aspect of the ankle. The joints are then fused together with the help of screws, wires, plates, or rods. Bone grafting is recommended in cases of substantial bone loss. This is done using a graft taken from the patient (autograft) or donor tissue (allograft). The recovery time following fusion will depend on the technique employed and the health status of the individual patient.
The post-operative guidelines to be followed immediately after ankle arthrodesis include:
- Keep your cast or dressing dry and do not remove for the specified time given by your surgeon
- Avoid bearing weight on the operated ankle joint and use crutches or wheelchairs for a few weeks
- Elevate the foot above heart level to minimize swelling.
- Eating a healthy diet and quitting smoking will help with healing.
Ankle arthrodesis is usually a safe procedure and complications are uncommon. However, apart from general complications related to any surgery, complications after ankle arthrodesis can include infection, nerve damage, unresolved pain, non-union of bones, excessive swelling and stiffness, and irritation from foreign material such as pins or screws.
Ankle Joint Replacement