Your ankle plays an important role in your everyday life. Additionally, it allows you to walk, run, jump, and more. Movements as simple as this can actually cause the cartilage in it to wear away. This condition is called Osteoarthritis.
Osteoarthritis is the most common type of arthritis. Moreover, it usually affects the hands, hips, and knees. However, although less common, it could affect the ankles too. When the cartilage wears away, it causes the bones to rub against each other, which could result in inflammation of the joints and pain.
The Ankle Joint and its Structures
The ankle joint, also called the talocrural joint, is a synovial hinge joint. The tibia and fibula (bones of the legs) and the talus (foot) form it. It allows a dorsiflexion and plantarflexion motion of the foot.
The plantarflexion of the foot is produced by the muscles gastrocnemius, soleus, plantaris, and posterior tibialis located at the posterior compartment of the leg. And the muscles produce the dorsiflexion of the foot tibialis anterior, extensor hallucis longus, and extensor digitorum longus located at the anterior compartment of the leg. The lateral compartment is composed of peroneus longus and peroneus brevis. Other movements, such as eversion and inversion, are produced by the subtalar joint.
Strong tibiofibular ligaments hold together the bones of the legs, tibia, and fibula. The bones form bracket-shaped sockets, also known as mortise, and hyaline cartilage covers them.
There are two main sets of ligaments, the medial and lateral ligaments. Both originate from each malleolus or the bony prominence on each side of the ankle.
The medial ligament, also known as the deltoid ligament, attaches to the medial malleolus. It has four ligaments that fan out and attach to the talus, calcaneus, and navicular bones. Its primary action is to prevent over-eversion of the foot.
The lateral ligament, which attaches to the lateral malleolus, comprises three separate ligaments. These are Anterior talofibular, Posterior talofibular, and Calcaneofibular. The anterior talofibular connects the lateral malleolus and lateral aspect of the talus, the posterior talofibular connects the lateral malleolus and the posterior aspect of the talus, and the calcaneofibular connects the lateral malleolus and the calcaneus.
How does Osteoarthritis occur in the ankle?
Osteoarthritis is a medical condition characterized by the gradual loss of cartilage in one or more joints. Because of its nature to develop associated with aging, it is also known as degenerative arthritis. When repeated stress is applied to a joint, the cartilage in the joint wears away over time. This causes the bones to lose their protective cover, and eventually, the bones rub against each other. When this happens, it causes pain and inflammation of the joint.
Osteoarthritis less commonly affects the ankle joint. This is because the fibula, tibial plafond, and medial malleolus bind the talus firmly together with other strong ligamentous attachments, which results in a better cartilage loading profile than the other joints. The cause of osteoarthritis in the ankle is not because of wear and tear but mostly because of trauma. Osteoarthritis can develop in your ankle after an injury, like fractures or repeated strains. Additional causes include arthropathies, chronic ankle instability, malalignment, certain medical conditions, such as hemophilia, and being flat-footed, bow-legged, knock-kneed, or high arches, as these put a lot of stress on your joints.
Moreover, when you have ankle osteoarthritis, you might feel pain in the ankle joint that gets worse with activity, swelling, stiffness, and limited ankle movements.
How is it diagnosed?
To diagnose this condition, your doctor will talk to you and perform some tests.
Your doctor will ask you questions about your family medical history, symptoms, onset or pattern of pain, activities that aggravate or relieves it, lifestyle, present and past medical history, and more. These things are important in diagnosing the condition and treatment.
For further information, a doctor may order the patient to have imaging tests such as X-rays and lab tests to confirm their diagnosis based on the patient’s symptoms.
Positive ankle osteoarthritis if there is a relative loss of joint space between the tibia and fibula and the talus bone. The presence of bone spurs, or the bony projections that form in the edge of the bone when it is damaged due to rubbing against each other, can indicate arthritis too.
2. Magnetic Resonance Imaging (MRI)
A more detailed imaging test than an X-ray, an MRI shows images of the soft tissue (ligaments, tendons, and muscle) as well as the bone. This can be helpful if the x-ray of the ankle is unclear or if the doctor suspects another condition other than osteoarthritis.
3. Lab tests
These are done not to diagnose osteoarthritis but to rule out other conditions that cause ankle pain, such as rheumatoid arthritis or gout.
Treating Ankle Osteoarthritis
Since ankle osteoarthritis is a degenerative disease, the process of cartilage loss can’t be reversed. However, with the right treatment and medications, it can be slowed down, and pain can be managed.
Lifestyle modifications can significantly reduce ankle arthritis pain. You can do these modifications at home and typically do not require a consultation with a doctor. Apply a warm or cold compress to improve ankle stiffness and joint pain.
Nonsurgical treatments include Shoe inserts, Rocker shoes, and Orthopedic supportive devices like braces or canes. Their goal is to take off or reduce the load or stress on the ankle joints.
Physical therapy also helps by strengthening the ankle’s soft tissues and surrounding muscles, increasing its range of motion and thus reducing the pressure on the ankle joints as well.
Over-the-counter medications, whether oral, topical, or prescription medications, are available to manage pain caused by this condition. Healthcare providers can use injections like steroids, hyaluronic acid (hyaluronate), platelet-rich plasma (PRP), and stem cells to relieve pain.
If these treatments do not succeed, surgery may be done if symptoms are severe. Several surgeries include Ankle debridement, Ankle arthrodiastasis, which involves a temporary device to be connected in the ankle, Ankle arthrodesis (tibiotalar arthrodesis or ankle fusion), and Ankle replacement (ankle arthroplasty) which replaces the joint with an artificial part.
How do Exercises help?
Exercise is a great way to relieve pain and improve stiffness caused by osteoarthritis. Your initial goal in doing exercises should be gaining a range of motion. Here are some exercises:
1. Ankle Pumps
Sit in a chair. Slightly lift off your feet on the ground to allow it to move freely. Then point your toes up to the ceiling. Hold this for 7 seconds. Then put it back in a resting position. Do this for 10 repetitions, 2-3 sets.
2. Ankle Rotation
Sit in a chair. Bring your affected ankle on your opposite knee and hold it. Gently rotate your ankle clockwise. Then do it counterclockwise. Do this for 10 repetitions, 2-3 sets.
3. Towel Pick Up
Sit in a chair. Put a towel under your feet. Pick up the towel by scrunching your toes. Do this for 10-20 repetitions.
4. Ankle Alphabet Writing
Sit in a chair with your feet flat on the ground. Lift the affected foot, then write the alphabet in the air with your big toe, by only moving your ankle. Try to write the whole alphabet at least twice.
5. Standing Heel Raise
Stand while holding onto a chair for support. Rise up with your toes with knees straight. Then slowly go back to the resting position. Do this for 10 repetitions, 2-3 sets.
Although ankle osteoarthritis can’t be cured, there are treatments available that could help relieve pain and improve function. Early treatment leads to a better prognosis, conserves joint integrity, improves daily functioning, and reduces the debilitating effects of pain and the need for future surgery.