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Sian Jones, Medical Secretary to Bal Dhinsa

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London Bridge Hospital
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London

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ANKLE ARTHRITIS

What is ankle arthritis?

Primary ankle arthritis is rare, with arthritis in this joint usually secondary to trauma or inflammatory arthropathy.

 

Typical Symptoms

Pain, swelling and stiffness are common complaints, particularly when walking for long distances or on uneven ground. As the arthritis progresses there may be significant deformity present which makes finding appropriate footwear a challenge and often uncomfortable.

 

Non-surgical management

In the early stages of the condition analgesics, non-steroidal anti-inflammatory medication and support with an ankle brace maybe of help. As the condition progresses an intra-articular injection with corticosteroid or a viscosupplement can be used for temporary relief.

 

Surgical management

If there is a mechanical block to ankle movements from bone

spurs (osteophytes) and the rest of the joint is well preserved, these osteophytes can be removed through keyhole (arthroscopic) or

open surgery.

 

With advanced arthritic changes, the surgical options are either an ankle fusion or ankle replacement. The fusion tends to be preferred for younger and more active patients as the results are more predictable in this population. Fusion can be performed either with arthroscopic or open surgery and involves the removal of the remaining cartilage and unhealthy bone from the joint surfaces.

Once the surfaces are prepared satisfactorily, the surfaces are brought together and held in place with screws or a plate. This stiffens the joint however there will be no pain, and the subsequent limp is subtle.

 

An ankle replacement preserves some motion in the ankle joint by replacing the worn cartilage on the joint surfaces with a metal prothesis, and there is a plastic insert between the two metal components. With preservation of joint motion there is less transferred stress to the other joints of the foot. Unfortunately, with excessive use they can wear and may need revision which can be a complicated procedure.

 

Risks of Surgery

As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, non-union, aseptic and septic loosening.

Recovery

If a bone spur removal procedure is performed, your foot and ankle will be in bandaging and a surgical boot will be provided to allow you to weight-bear whilst protecting the ankle. You will be provided with crutches for support. Elevation, as much as possible, is important in the first few weeks. The bandaging will come down at 2 weeks and dressings changed, and at this stage you will be referred for physiotherapy if the wounds are fully healed. You can go back to wearing comfortable shoes at this stage. Return to work can be considered at this stage if the wound is fully healed.

 

If a fusion procedure has been performed your leg will be placed in a below-knee cast for 2 weeks, and at this stage a wound check will be performed, and a complete below-knee cast applied for a further 4 weeks. For this initial 6 weeks no weight-bearing will be allowed, and crutches will be supplied for support. Elevation, above the heart level, as much as possible, is important. After 6 weeks, a walking boot will be applied, and weight-bearing will be permitted in the boot for 6 weeks and physiotherapy instigated.

 

Swelling can be expected to be present for up to 6 months, particularly in the evenings.

 

With regards to return to work, it is dependent on the amount of weightbearing required. If the work is sedentary and you can keep the foot elevated, then return after 6 weeks is satisfactory. Otherwise, return to work should be expected after 12 weeks.

 

For ankle replacements your leg will be placed in a below-knee cast for 2 weeks and not allowed to weight-bear. Elevation above the heart level, as much as possible, is important. At the 2-week stage a wound check will be performed and if the wound has healed the leg will be placed in a walking boot and full weight-bearing permitted. Physiotherapy will also be started at this stage. The walking boot will be required for weight-bearing for approximately 4 weeks, at which stage you can get into supportive shoes.

 

With regards to return to work, it is dependent on the amount of weightbearing required. If the work is sedentary and you can keep the foot elevated, then return after 6 weeks is satisfactory. Otherwise, return to work should be expected after 12 weeks.