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 Cary B. Chapman, M.D., PLLC
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The bone ends of a joint are covered with cartilage, which cushions the bone and allows the joint to move smoothly without pain. Arthritis occurs when there is deterioration or wearing away of joint cartilage. The normal smooth lining of a joint surface becomes rough and irregular, which causes pain. Unfortunately, the body cannot repair the damaged cartilage. Arthritis can occur at any joint in the foot and ankle region, although the ankle joint itself is most commonly affected. There are different types of arthritis, including osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Osteoarthritis (OA) is partly due to genetics, and partly an inherent consequence of aging. People usually begin feeling the effects of osteoarthritis in their 60’s. Rheumatoid arthritis is characterized by joint inflammation affecting numerous joints, and often begins at a young age. As the name implies, post-traumatic arthritis occurs as a result of a single or recurrent injuries to a joint surface. In the ankle, this is usually the result of an ankle fracture. • Treatment Milder cases of arthritis can be treated with oral medications, such as anti-inflammatory medications. Ankle braces or shoe inserts (orthotics) may also help to stabilize and support the affected joint. An exercise program can also be helpful. This should focus on non-impact exercises (bicycling, swimming) to strengthen the muscles around the foot and ankle and to maintain motion in the joints. You might benefit from a course of physical therapy to teach appropriate exercises that will not exacerbate the arthritis pain. Finally, avoiding painful activities (running, vigorous hiking) is important, as pain may be an indication that you are causing additional damage to your joint. In more severe and painful cases of arthritis, a cortisone injection may be offered to calm the pain and swelling. Cortisone shots may last for a few weeks to several months, although sometimes they do not provide any pain relief. Complete immobilization of the foot and ankle in a brace or cast is also very effective for relieving pain, although it is often difficult to use such a device for more than a few weeks. • 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 (the metatarsophalangeal joint) and in the ankle joint. In the big toe, the bone spurs can be removed using a small incision (Cheilectomy), 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 (1/4 inch in size) 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. • Surgical treatment of arthritis: joint fusion In those cases, a joint fusion, also known as joint arthrodesis may be offered. A fusion surgery freezes the joint in place, eliminating all the motion at the affected joint. However, the motion is maintained at the adjacent joints, and often there is little residual functional loss following a joint fusion. Also, by the time a joint fusion is offered, most of the motion at the joint has already been lost due to the arthritis. Joint fusion is an extremely effective method for relieving pain in an arthritic joint. Common areas that are fused include the first metatarsophalangeal joint, the tarsometatarsal joints, the hindfoot joints and the ankle joint. • Ankle joint replacement In the past 5 years, ankle joint replacements have become a good treatment option for advanced ankle arthritis in many patients. New joint replacements (prostheses) have become available that last longer and provide good pain relief. An ankle joint replacement has the advantage that it cures the problem of arthritis in the ankle but does not sacrifice motion. Maintaining ankle motion helps make a more normal walking pattern, and also prevents the wearing out of other joints in the foot that can occur after an ankle joint fusion. However, most joint replacements have a finite life span. Therefore a young or active individual may require a revision of their joint replacement or changing the replacement to a fusion after a certain amount of time Dr. Chapman is trained and experienced in treating arthritis of the foot and ankle, including ankle replacement. |
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