Stages Of Ankle Arthritis
There are three stages of ankle arthritis, with each stage increasing in severity compared with the stage before it.
Early-stage arthritis of the ankle
In the early stages of ankle arthritis, naturally occurring fluids are still flowing into the joint cavity and aiding the movement of the joint. Cartilage, however, has started to degrade, wear thin and bone spurs will start to form. Patients will find that ankle joints will start to feel uncomfortable, especially after extended periods of being stood or walking around. This is often a good time to start with ankle exercises for arthritis as its important to keep the joint mobile and encourage pain-free movement where possible and prevent fibrosis or adhesion in the joint and joint capsule.
Mid-stage arthritis of the ankle
Ankle arthritis symptoms become harder to ignore. As the pain begins to worsen throughout the day, patients may also find that the joint gives way unexpectedly. Running, jogging, or even just walking for long periods can result in a lot of pain for the patient. There may also be some stiffness in the mornings. Cartilage continues to be worn down and the spaces between the bones that make up the ankle will begin to narrow. At this point, bones will thicken and spurs start appearing along the joint margins.
Late-stage arthritis of the ankle
Deformities Of The Knee
The appearance of the knee can change during a flare and as damage progresses.
In RA, swelling and redness are common during a flare. In the long term, persistent inflammation can result in permanent damage to the cartilage and the tendons. This can affect the shape and appearance of the knee.
With OA, the muscles around the knee can weaken, resulting in a sunken appearance. The knees can start to point toward each other or bend outward.
Knee deformities range from barely noticeable to severe and debilitating.
Treatment will depend on the type of arthritis a person has.
Surgical Treatment Of Arthritis: Removal Of Bone Spurs
Surgery is indicated when the above non-operative measures do not relieve the pain or allow return to a reasonable level of function. The procedure that is offered to the patient depends on where the arthritis is located and what is causing the symptoms. In many cases, arthritis causes bone spurs to develop on the edges of the joints. If the spurs are the major cause of the symptoms, then surgical removal of the bone spurs may be all that is necessary to relieve pain and joint stiffness. This is especially true in the big toe joint and in the ankle joint. In the big toe, the bone spurs can be removed using a small incision, which often greatly improves the range of motion in the big toe, and relieves pain from pressure on the top of the toe. This procedure can often be used in the big toe even when the arthritis is fairly advanced.
In the ankle joint, bone spurs can be removed arthroscopically. Arthroscopic surgery involves 2 or 3 small incisions and the use of a small camera to perform the operation. Removing the bone spurs decreases pain and may improve motion in the ankle. However, this procedure is not as effective if there are generalized arthritic changes present in the joint.
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What Happens During Ankle Fusion
Your healthcare provider can help explain the details of your particular surgery. An orthopedic surgeon will perform your ankle fusion aided by a team of specialized healthcare professionals. The whole operation may take a few hours. In general, you can expect the following:
- You may have spinal anesthesia. This is so you wont feel anything from your waist down. Youll also likely be given sedation to relax you. Or you may be given general anesthesia. This will prevent pain and make you sleep through the surgery.
- A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.
- The surgeon will make an incision through the skin and muscle of your ankle, and likely another one on your foot. If you have minimally invasive surgery, the surgeon will make a smaller incision. He or she will then use a tiny camera with a light to help do the surgery.
- Your surgeon will remove any remaining cartilage from the affected joint. He or she will connect the bones together in the proper position using hardware as needed.
- Your surgeon will make any other repairs that are needed.
- The team will close the layers of skin and muscle around your ankle and foot with stitches or staples.
Treatments For Arthritis In The Ankle
Ankle arthritis doesnt have a cure. But many treatments are available that may help relieve pain and improve function.
The goal with these treatments is to help patients function and do their daily activities with less pain, says Narandra Bethina, MD, a rheumatologist at the University of Vermont Medical Center and assistant professor at the Robert Larner, MD College of Medicine at the University of Vermont in Burlington. This can also result in better quality of life.
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Lifestyle Changes And Home Remedies For Arthritis In The Ankle
Lifestyle modifications are a big part of helping treat arthritis in the ankle. The most important lifestyle change a patient can make is a commitment to healthy eating and exercise, says Dr. Archer. Unfortunately, pain from arthritis can force a patient to become more sedentary, which in turn can cause depression and overeating. Diet is 80 percent to 90 percent of the battle.
Soothe with heat and ice: Stiff and sore ankles can be relaxed and soothed with heat therapy. Ice can help numb areas affected by joint pain and reduce inflammation. Ice therapy is helpful for acute exacerbation of arthritis symptoms , and heat is good for chronic pain symptoms, says Dr. Archer.
Do ankle-friendly exercise: Its important to control your weight with regular, low-impact aerobic exercise. Keeping your weight close to your ideal BMI is the best thing you can do to control your pain and symptoms, says Dr. Archer. As little as a 10-pound weight gain can increase stress on your ankle. This extra weight can weaken tendons and ligaments, which makes sprains and strains more likely.
Do gentle exercises that dont stress the ankle joint, such as swimming or cycling. Walking is one of the best exercises if done correctly with good shoes, says Dr. Bhatt. Limit high-impact activities, such as running or tennis. Also stay away from soccer and kickboxing, says Dr. Bhatt.
Looking After Your Feet
Its important to take care of your feet if you have osteoarthritis in your feet or ankles. A good footcare plan can help reduce the likelihood of you developing other problems that could make your pain worse, such as corns, calluses, or ingrown toenails.
There are a number of things you can do yourself, including:
- washing your feet every day in warm, soapy water dont soak your feet unless you have problems with hard skin or ingrown toenails
- drying your feet well, including in between your toes
- moisturising your feet all over, except for between your toes
- cutting your toenails regularly, cutting straight across the nail doing it at an angle or down the sides could lead to ingrown toenails.
If you have corns or calluses, try:
- soaking your feet in warm water to soften the skin
- using a pumice stone or foot file to remove hard skin
- moisturising your feet to keep the skin soft.
Its a good idea to get your feet checked regularly by your GP or a podiatrist. This is important if you have any problems with your feet that dont get better after a few weeks.
Podiatry
Podiatrists , also known as chiropodists, are specialists in treating foot problems. You can either be referred to an NHS podiatrist by your GP or, in some areas, you can refer yourself.
You could also pay to see one privately. Either way, you should make sure theyre registered with the Health and Care Professionals Council .
Footwear
When getting new shoes, consider the following tips:
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Active Range Of Motion Ankle Exercises For Arthritis
- Ankle dorsiflexion/plantarflexion AROM, on a table
In long sitting on top of a table/bed or a plinth, place your ankles over the edge of the table. Now move the ankles upwards towards you and then downwards towards the floor.
- Active ankle range of motion in dorsiflexion
Lay on your back and bend one knee and place it on the ground. Now try to bend your ankle upwards towards the ceiling and then back towards the floor.
- Long sitting ankle inversion/eversion
In long sitting, place the injured foot straight in front of you. Now try to curl your foot inwards and then outwards. Making sure not to create the movement using your knees.
- Seated active ankle mobility
Lay on your back and place the injured leg in front of you with a straight knee. Now try to move your ankle upwards, downwards curling it in as well as out, and at the end perform circular motions of the ankle.
- Sitting, Ankle active dorsiflexion and plantarflexion with foot glide on the floor
Sit on a chair and place both legs in front of you. Now try to move the affected ankle forwards, away from you and backward, towards the chair.
The Connection Between Enthesitis And Psoriatic Arthritis
While joint pain is a key sign of PsA, pain in the ankle area is also often due to inflammation of the enthesis, the area where the tendon or ligament inserts into a bone to facilitate joint motion. This inflammation, which is known as enthesitis, is very common in PsA.
Enthesitis has been reported to occur in 35 to 50 percent of people with psoriatic arthritis, according to a 2018 paper in the journal Seminars in Arthritis and Rheumatism.
The ankle is one of the most prominent places for enthesitis and its one of the most challenging features of PsA, explains Dr. Domingues. Its another source of pain and other issues for patients with PsA.
Enthesitis is unique to psoriatic arthritis and other kinds of spondyloarthritis.
Enthesitis doesnt commonly occur with other forms of arthritis like rheumatoid arthritis or osteoarthritis . Enthesitis is such a common hallmark of PsA that health care providers often look for its presence to confirm that joint symptoms are a symptom of PsA and not another type of arthritis.
You may not be familiar with the term enthesitis, but youve no doubt heard of one of the most well-known examples of enthesitis tennis elbow, the inflammation of the tendon that attaches your forearm muscle to the elbow. This ache on the outside of your elbow is usually brought on by repetitive motion and given enough rest gets better on its own.
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Symptoms Of Arthritis Of The Ankle
- Start-up pain .
- Morning resting pain.
- Reduced walking distance .
- Friction rub.
- Swelling and inflammation.
- Deformation of the joint.
- Obstructions in the joint due to impingement of soft parts, cartilage and bony parts in the joint.
- Painful walking on uneven ground or terrain.
During the medical consultation, severe ankle pain and swelling are usually mentioned as the reason for the visit. Pain still occurring depending on strain, so immediately after sports or after a hike, indicates an early stage of arthritis of the ankle. Resting pain and persistent pain in the ankle indicate advanced arthritis of the ankle to the physician.
Another indication of arthritis of the ankle is rapid fatigue with strain.
The ankle disease initially only causes occasional ankle pain in the afflicted person after straining the leg more than usual.
Ankle problems become more frequent as the disease progresses and the resilience to stress declines. The flexibility of the ankle is reduced by recurring inflammation of the joint capsule and resting the foot due to the pain results in limping.
Depending on the severity of the damage in the ankle, different problems may arise. In the early stages, typical problems with the ankle related to arthritis are occasional pain or fatigue in the ankle.
Morning start-up pain or ankle pain after extended periods of rest are relatively typical. Pain in the ankle after strain or even resting pain only occur as the arthritis progresses.
Stages And Morphology Of Arthritis Of The Ankle
Why does ligament instability cause arthritis?
Just as with other joints, the wear leads to depletion of cartilage – and consequently narrowing of the joint space.
The so-called joint space is the invisible cartilage layer in the X-ray. If it’s still pronounced, the joint-forming bones in the ankle maintain a distance: They form the joint space.If the joint space shrinks due to cartilage abrasion and arthritis, stress to the adjoining bone and cartilage abrasion increase.
More and more of the cushioning function of the joint cartilage in the ankle is lost. The consequence is inflammation including swelling of the ankle.Protruding bone forms at the edges of the ankle, where the bones rub together and crunch as the joint space becomes more narrow in the ankle.
These bone spurs are a result of the cartilage damages and mark the transition to arthritis of the ankle.
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How Does Arthritis Of The Ankle Feel
With arthritis of the ankle, the patient feels as though he or she first has to “warm up the ankle” after a period of sitting or resting. The joint is “stiff” and frequently swollen as well. It is also not able to handle strain as well any more: Following physical strain, the ankle afflicted by arthritis is still sore and swollen days later. The quality of life declines greatly, as ankle pain increases whilst walking, when suffering from arthritis of the ankle.
Movement accompanied by shock to the joint, such as jogging or playing tennis, becomes totally impossible. The ankle aches and stiffens.Arthritis of the talocalcaneal joint is also a widespread disease. In the final stages of arthritis, the ankle is painfully stiff. It is then replaced with an ankle prosthesis or stiffened through arthrodesis. This allows the patient with severe arthritis of the ankle to remain mobile in everyday life.
What Does It Feel Like
RA pain in your ankles may be difficult to pinpoint at first. Your ankle may hurt in the morning, or at night, but not constantly.
At first, you may notice difficulty in walking uphill, or on ramps or steps. This movement puts more pressure on your ankles.
The pain is different from that of a fracture or strain, and not sharp. But the swelling, warmth, and redness may be similar to those that come from ankle trauma.
As RA progresses, symptoms will intensify and occur more frequently.
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Bursitis In The Foot Or Ankle
Bursitis causes pain and inflammation, commonly around hard-working joints such as in the big toe, ball of the foot, heel, or ankle. It can also affect any part of the body.
It is caused by swelling in a small pocket of fluid, known as a bursa, or bursae if more than one is affected. Normally these small pouches cushion and protect your bones, joints, and tendons from impact, rubbing or pressure.
However, repeated rubbing, friction, excessive pressure, or injury can cause the fluid inside to increase making the affected bursa inflamed and tender.
For example, you can get bursitis between your ankle and heel if you keep wearing shoes that rub, pinch, or press down on the area. Shoes that are too tight and high heels regularly cause bursitis.
It often appears as a red, painful, swollen lump. However, it can also cause general swelling that you only notice because of the pain, for instance on the bottom of your heel.
People with bunions or irritated joints can be prone to bursitis. Rheumatoid arthritis can also cause bursitis, particularly in the ball of the foot.
The self-care tips recommended earlier should help relieve your pain and inflammation. However, instead of bandaging the area, try using adhesive padding on the swelling to protect it from further friction and pressure. Resting it on a cushion can also help.
If you find self-care treatments are not helping speak to a healthcare professional.
Medication For Arthritis In The Ankle
Medications are an important part of treatment for arthritis in the ankle. They can help slow bone loss, relieve inflammation, and ease pain. Here are the types of medications used commonly in arthritis treatment.
Nonsteroidal anti-inflammatory drugs: Over-the-counter medications like ibuprofen and naproxen , as well as prescription NSAIDs, can help relieve pain and swelling in the joints. Even though many NSAIDs are available over the counter, they can have side effects especially when taken for the long term and/or in high doses.
Oral corticosteroids: These quick-acting drugs help stop inflammation and are often used to manage flares in rheumatoid arthritis and gout, says Rajat Bhatt, MD, a community rheumatologist with offices in Richmond, Pearland and Greater Heights, Texas. Its best to use corticosteroids in the lowest possible dose for short periods of time, as they can cause a range of serious side effects, including bone thinning and high blood sugar.
Steroid injections: In certain cases, steroid injections into the ankle joint can help relieve inflammation. These shots shouldnt be done repeatedly, though. Frequent injections damage cartilage, says Dr. Bhatt. Also, we try avoiding tendon injections and tendon ligaments close to the joint. An occasional shot, though, can offer temporary pain relief and reduce inflammation. No more than three injections per year is the standard of care, says Dr. Archer.
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How Do I Prepare For Ankle Fusion
Talk with your healthcare provider how to prepare for your surgery. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, youll need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.
Before your surgery, you may need imaging tests. These may include CT scan, ultrasound, X-rays, or magnetic resonance imaging .
Do not eat or drink after midnight the night before your surgery. Tell your healthcare provider about any recent changes in your health, such as a fever.
You may need to plan some changes at home to help you recover. This is because you wont be able to walk on your foot normally for a while. Plan to have someone drive you home from the hospital.