Remember that sprained ankle you suffered years ago? Or maybe it was an ankle fracture that left you hobbling around for weeks. Whatever the specific problem, be forewarned that ankle injuries can come back to haunt you—years or even decades later. Here’s how…
SELF-CARE FOR ARTHRITIS
The ankle is vulnerable to the same types of arthritis that affect other joints. Post-traumatic arthritis is the most common form in the ankle, followed by age–related osteoarthritis and rheumatoid arthritis. For these forms of ankle arthritis, you might be able to manage discomfort with simple remedies.
But self-care is tricky. You can’t “go easy” on the ankles in the same way that you would with certain other joints. People use their ankles all day, every day. My advice for people with ankle arthritis…
• Choose activities that minimize ankle wear and tear. To stay active and keep the muscles supporting the ankle strong, try biking, swimming, walking, rowing, elliptical workouts or other low-impact, weight-bearing exercises that don’t cause relentless pounding.
• Keep your weight down. People with ankle arthritis tend to gain weight because they find it too painful to walk or exercise much…and the extra pounds accelerate joint damage by increasing the weight load on the ankles. Helpful: Losing even five pounds can reduce the ankle load by 20 pounds, which may be enough to minimize symptoms.
• Exercise the ankles. Ankle-specific exercises will build up the muscles surrounding the joint, keep the joint from getting stiff and reduce the bone-on-bone friction that occurs with arthritis. Example: Several times a day, flex your foot upward (dorsiflexion) as far as it will go…hold for a few seconds…then flex it downward (plantarflexion). You can find dozens of ankle exercises on the Internet.
• Wear shock-absorbing shoes. Also known as “stability sneakers,” they have a densely cushioned heel/sole that absorbs shocks when you walk, exercise, etc.
NOT READY FOR SURGERY
In addition to the steps above, some simple therapies can help slow the progression of arthritis. For example, it may help to wear an over-the-counter ankle brace that gives support and stability…apply cold packs when the ankle is hurting…and/or take as-needed doses of a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin) or naproxen (Aleve).* If you’re lucky, these and other self-care therapies—including physical therapy—may be the only treatments you’ll ever need.
Very helpful: A cortisone injection. Cortisone (sometimes combined with lidocaine) is a strong anti-inflammatory that can reduce or eliminate pain within a day. The shot is good for patients who are having moderate daily pain—and might be helpful for an upcoming vacation, for example, or when the pain is unusually severe. This shot won’t stop the arthritis but can get you through a rough patch. In some cases, hyaluronic acid injections may be used but may not be covered by insurance.
WHEN SURGERY IS NEEDED
Even with the approaches described earlier, many people will eventually develop “end-stage” arthritis that does not improve and interferes with their daily activities. Once ankle arthritis progresses to that extent, it’s serious business.
Until about 10 years ago, most patients with end-stage ankle arthritis were advised to have a procedure called ankle arthrodesis, commonly known as ankle fusion because affected bones are fused together to reduce pain and inflammation. Now, patients (based on their age and other factors) have a second option—a total ankle replacement.
Because long-term comprehensive studies haven’t yet been done, there’s still debate about which approach is better. Both procedures are effective…and both have downsides that patients need to know about. Specifically…
• With ankle fusion, the affected bones are locked together (with screws alone or plates and screws) and eventually fuse into a solid mass of bone. This eliminates the rubbing/friction that causes the pain and disability of ankle arthritis. Most patients will walk in a shoe (without a cast) in eight to 12 weeks. And unlike ankle replacement (discussed below), the procedure is permanent. You’re unlikely to require an additional procedure unless it doesn’t fuse.
Downside: Bone fusion eliminates ankle mobility. You might walk haltingly when you go up hills or down a flight of stairs. And because the ankle is locked in place, other structures in the foot assume more of the burden of daily movements—and could become more susceptible to arthritis.
Ankle fusion might not be the best choice if you have a highly active lifestyle that involves, for example, strenuous hiking, tennis, etc., and want your ankle to move “naturally”…or if you have other arthritic areas of your foot that couldn’t take on more responsibility when the ankle is locked up.
• With a total ankle replacement, the arthritic surfaces are replaced—as also occurs with a knee or hip replacement—with an artificial joint. Surgeons advise patients that the implants might last for eight to 12 years. A recent study found that 73% were still working after 15 years.
The advantage of total ankle -replacement is that the ankle will flex. Patients retain a greater degree of motion and experience less stress on surrounding joints.
Downside: The risk for additional procedures to repair/replace a damaged implant.
My take: I might recommend joint replacement for someone who’s over age 60 and in good health but has other arthritis in the foot…or a person who is active with sports, such as tennis, that involve jumping and cutting. However, the choice between fusion and replacement is highly individualized.
Important: See a surgeon who’s experienced in both procedures to get an unbiased opinion about the pros and cons of each. To find such a surgeon near you, consult the American Orthopaedic Foot & Ankle Society, AOFAS.org.
Insurance typically covers these procedures, but be sure to ask.
*Discuss the use of NSAIDs with your physician—they can cause side effects such as stomach upset, ulcers and high blood pressure.