Ankle Arthritis

• Weight-bearing X-rays are required
• Long leg X-rays, CT scans or MRI scans may be required

• Topical pain creams e.g. NSAIDS
• Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
• Lace up ankle brace
• Shoe wear modification
  • lace up ankle boots
  • stiffer-soled shoe with rocker bottom modification
• Activity modification
  • improve fitness and strength via non axial loading exercises e.g. cycling, swimming.
  • avoid axial loading exercises e.g. running
• Weight loss management
• Joint injections
• Occasionally viscosupplementation may help

Surgery is considered if symptoms are progressing and function is decreasing after a trial of non-surgical treatment. Depending on the extent of disease, surgical options may include:

• Arthroscopic procedures
  If bony impingement is contributing or causing symptoms and osteoarthrits is not widespread throughout the joint

• Bone realignment osteotomy
  If osteoarthritis is focal then shifting the bone alignment may help decompress the painful area

• Ankle fusion: open or arthroscopic
  If osteoarthritis is advanced and the patient suffers significant symptoms on a daily basis. More suited for younger, more active patients and those who work in manual labouring positions

• Total ankle replacement
  Many factors are used to determine if a patient is suitable for joint replacement. This includes if osteoarthritis is advanced and the patient suffers significant symptoms on a daily basis. It is more suitable for older people who are not in manual labourer positions and whose activity can be restricted to lighter weight activities

• Tibiotalocalcaneal Fusion (With Intramedullary Rod)
  This surgical procedure fuses your ankle joint with a rod commonly called a “nail.” It passes through the bones of your foot and lower leg. This type of fusion can be helpful if you have severe arthritis or other serious problems with your ankle. It may also be needed if you have had a total ankle replacement that has failed.

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

• Infection: superficial wounds or deep infections
• Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
• Nerve damage: tingling, numbness or burning
• Ongoing pain
• Stiffness of the ankle joint
• General or anaesthetic risks including to the heart and lung
• Drug reactions/allergy
• Scarring or tethering of the skin
• Rerupture
• Calf weakness
• Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.