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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
Feel:
  • Pulses
  • Bony or soft tissue swelling
  • Tenderness localised to ankle joint / behind malleoli “ think tendon impingement / tendonitis
  • Tenderness over ST joint line
Move:
  • 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
Aetiology
  • 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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Accessory Bones
Adult Hallux Valgus
Amputations of the Foot & Ankle
Anatomy of the Foot & Ankle
Ankle Arthritis
Ankle Fractures
Ankle Instability
Ankle Sprains
Arthritis in Children
Arthrodeses of the Foot & Ankle
Arthroscopy of the Foot & Ankle
Bibliography
Biomechanics of the Foot & Ankle
BOFSS Syllabus for FRCS (Tr & Orth)
Bunionettes
Calcaneal Fractures
Compartment Syndrome
Diabetic Foot
Foot & Ankle Hyperbook
Foot & Heel Pain
Freiberg's disease
Hallux Rigidus
Hyperkeratotic Pathology of the Pla...
Lesser Toe Deformities
Lisfranc Fractures
Morton's Neuroma
OCD & Osteochondoses of the Foot & ...
Other Foot Fractures
Peroneal Tendon Injuries
Rheumatoid Foot
Rheumatoid Forefoot
Sesamoids
Sinus Tarsi Syndrome
Soft Tissue Impingement
Tarsal Tunnel Syndrome & Nerve Entr...
Tendo Achilles Disorders
tendo achilles references
Tendon Disorders
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