Prof Mason

Liverpool Foot and Ankle Clinic


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Phone : 01515221860

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Ankle Arthritis

Ankle arthritis occurs when the smooth cartilage that cushions the ankle joint wears away. This causes the bones to rub together, leading to pain, stiffness, swelling, and reduced movement. It can make everyday activities like walking, climbing stairs, or standing for long periods difficult and painful.

Unlike the hip or knee, where wear-and-tear arthritis (osteoarthritis) is most common, ankle arthritis often develops after an injury, such as a fracture or repeated sprains.

What causes ankle arthritis?

Several factors may lead to arthritis in the ankle joint, including:


  • Post-traumatic arthritis: The most common cause, typically following a broken ankle, dislocation, or repeated sprains.


  • Osteoarthritis: Age-related wear of the cartilage, less common in the ankle than other joints.


  • Inflammatory arthritis: Conditions such as rheumatoid arthritis or psoriatic arthritis can inflame and damage the ankle joint.


  • Avascular necrosis: Poor blood supply to the bone, especially the talus, leading to joint collapse.


  • Foot deformity: Conditions like flat feet or high-arched feet can cause abnormal joint stresses.


Symptoms

The symptoms of ankle arthritis can vary in severity but generally progress over time. Common symptoms include:


Pain

  • Aching or sharp pain in the ankle, especially during or after activity
  • Pain may be constant or come and go
  • Often worse with walking, standing, or going up/down slopes
  • Often worse on startup (e.g. standing form sitting)


 Stiffness

  • Difficulty moving the ankle, particularly after periods of rest (e.g., in the morning)
  • Reduced ability to flex or extend the foot


 Swelling

  • Swelling around the ankle joint that may worsen with activity or at the end of the day


 Instability or Weakness

  • The ankle may feel like it could “give way”
  • You may struggle with uneven ground or lose confidence in your footing


 Grinding or Catching Sensation

  • A feeling of grinding, clicking, or catching within the joint during movement


 Deformity

  • In more advanced cases, the ankle may appear crooked or misaligned due to joint degeneration


These symptoms may initially be mild and only present during high-impact activity. Over time, however, they can interfere with everyday tasks like walking, climbing stairs, or standing for long periods. If you're experiencing any of these symptoms, a specialist assessment can help determine the underlying cause and appropriate treatment.


What are the treatments for ankle arthritis?

Treatment is tailored to your symptoms, lifestyle, and stage of arthritis. At Liverpool Foot and Ankle, we provide both non-surgical and surgical options:


Non-Surgical Treatments


  • Pain relief: Medications such as anti-inflammatories and paracetamol.


  • Footwear modification: Supportive or rocker-soled shoes.


  • Custom orthotics: Insoles or ankle braces to reduce joint loading.


  • Physiotherapy: To maintain strength and motion.


  • Steroid injections: May offer temporary pain relief and reduce inflammation.


Surgical Treatments


If symptoms persist, surgical options include:


  • Arthroscopic debridement: Keyhole surgery to clean the joint is possible in the early stages of arthritis. This often includes removal of bone on the front of the ankle, called a cheilectomy.


  • Osteotomy: Realignment surgery to offload damaged areas. This may be performed above the ankle (supramalleolar osteotomy) or at the calcaneum.


  • Ankle Distraction Arthroesis: Use of a cage (external fixator) to distract the joint, promoting formation of scar tissue in the joint.


  • Ankle fusion (arthrodesis): Fusing the bones to eliminate pain by stopping movement in the joint.


  • Total ankle replacement (TAR): Replacing the joint with a prosthesis to maintain movement.


Ankle Arthrodesis

This is an example of an ankle arthrodesis

What are the differences between ankle fusion (arthrodesis) and ankle fusion?

Feature Ankle fusion Total Ankle Replacement
Pain Relief Excellent; removes painful movement Excellent, assuming implant is well aligned
Movement No ankle motion post-op, but can maintain some movement at midfoot joints Preserves ankle movement, more natural gait
Function High satisfaction on flat ground; limited incline walking Higher function on uneven ground/inclines
Impact on other joints Can increase stress on nearby joints resulting in symptomatic arthritis in 25% at 10 years Less stress on adjacent joints due to preserved motion
Durability Permanent if solid fusion occurs In time TAR will wear out. Revision rates at 10 years are estimated to be between 10 and 20% Modern implants last 10–15+ years
Need for further surgery 10–15% may need hardware removal; ~5–10% need revision 20–25% may need minor or major revision at 5–10 years
Complexity of revision Easier to revise Significantly more complex
Best for ... Young, very active patients; poor bone quality; large deformity Patients with good bone and joint alignment who wish to maintain motion