Ankle Arthritis

Updated by Alex Wee, 2005

Presentation:

• Pain, may be referred to knee
• Deformity “ valgus or varus
• Stiffness “ particularly in dorsiflexion
• Crepitus
• Ask about smoking / DM / PVD “ 4X rate of complications in smokers

Examination
Look :

• Skin quality / colour / ulceration
• Deformity
• Gait
• Opposite side
• Single heel raise “ if significant valgus deformity

• Pulses
• Bony or soft tissue swelling
• Tenderness localised to ankle joint / behind malleoli “ think tendon impingement / tendonitis
• Tenderness over ST joint line

• Check for ROM, check with knee flexed and fully extended
• Lock ankle joint and check for ST joint movement, and irritability

Investigations

Weight bearing films: 

• All weight bearing “ ankle mortise and lateral ankle
• Supplementary investigations only if required:
• Inflammatory markers if indicated
• WCC labelled bone scan if infection is suspected
• MRI “ with AVN talus
• CT to assess degree of bony collapse “ with AVN it tends to be central collapse of the dome with the periphery remaining intact

• Most commonly due to either previous trauma or osteoarthritis
• Previous ankle fractures “ displacement of the ankle mortise of 1mm results in increase of 40% contact stresses at the ankle joint. The ankle joint takes 5-7x body weight
• Inflammatory arthropathies e.g.: rheumatoid arthritis is less common

Treatment of ankle arthritis

Non-operative treatments:

• Activity modification
• Weight loss
• AFO / Rocker bottom shoe / Moulded or leather ankle brace - orthotics can provide good symptom relief, and stability, although
  
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