What Can Be Done About My Ankle Arthritis?
Dr. Christopher Hyer
Foot & Ankle Specialist
Ortho Montana-Bozeman
I often see patients who know they have ankle arthritis, but don’t really understand what that means and what (if anything) can be done about it?
So, what is arthritis? Arthritis means that you are experiencing loss of the cartilage in that joint. The cartilage is the spongey surface on the end of each bone that makes up the joint and acts like a slick, slippery surface so the joint can move without grinding bone on bone. As you lose the cartilage, you experience soreness, stiffness and pain.
Why did my joint get arthritis? Ankle arthritis often is related to prior injuries, chronic wear and tear, autoimmune conditions like rheumatoid arthritis, or genetics. If you have arthritis in other joints like your knees or hips, you are more likely to get it in your ankles as well.
So, what can I do about it? Well, we work on trying to preserve the cartilage you have and decrease the wear and tear. This might mean activity modifications like switching to cycling and hiking instead of distance running and jumping. Also, reducing the motion of the arthritic joint will help reduce pain and wear and tear. So, above-ankle hiking boots or ankle bracing/supports can be helpful. Also controlling the inflammation and symptoms with anti-inflammatories, topical CBD products, nutrient supplements like Glucosamine, Chondroitin and Turmeric as well as physical therapy modalities are part of the plan. Injections like cortisone (steroid) and/or PRP (platelet rich plasma) with anti-inflammatory protein concentrate can also be therapeutic.
What if all of that isn’t working anymore? There are surgeries to consider if the pain is persistent and limiting quality of life. So, since the pain is due to missing cartilage causing bone-on-bone grinding, two main options exist:
- Ankle fusion (Arthrodesis)- This is basically ‘welding’ the two bones of the ankle together, so the joint doesn’t move anymore and thus, doesn’t hurt. People inherently dislike the idea of losing motion from a joint permanently but there are pros and cons to this technique and in some cases, this may be a good option.
- Ankle replacement (TAR)- Like having your hip, knee or shoulder replaced, this is a metallic implant replacement of the arthritic ankle. Again, since the grinding of bone on bone is eliminated, there is pain relief but also with preserving motion at the ankle (not fused). Likewise, there are pros and cons here too and each patient is unique. Ankle replacements have advanced considerably in the past 20 years with multiple primary options, revision options and now the long-term outcomes are on par with knee and hip replacements.
In general, most of my patients prefer having an ankle replacement over ankle fusion when all other factors are equal. The recovery time is quicker, there is continued motion of the ankle with a more normal gait and there is pain relief.
If I have an ankle replacement, what can and can’t I do afterward? Just like a knee or hip replacement, this is a mechanical part. The better you take care of it, the longer it will last. So, if you can cycle, hike and play pickleball instead of long-distance run, deadlifting 350 pounds and kickboxing, you can expect the joint replacement to do well and for a long time.
So, does that mean I can’t run after an ankle replacement? No. If you are being chased by a mountain lion, you and your ankle replacement should run! But, if you are running as a matter of staying in shape, it would be better for the long term to convert to cycling or swimming or other lower impact activity.
With so much to enjoy here in Montana, from everyday activities to the trails and adventures right outside our doors, staying mobile matters. Ankle arthritis doesn’t have to limit that. There are proven treatments to manage pain, maintain function, and keep you moving comfortably. From bracing and therapy to advanced ankle replacement, your options are wide-ranging—and your orthopedic specialist can help you find the approach that fits your life.
Dr. Hyer is a fellowship-trained foot & ankle surgeon with Ortho Montana-Bozeman.
https://montanabones.com/team/christopher-f-hyer-dpm/
View this article in the Bozeman Daily Chronicle