In both cases the cartilage, which is the shiny white gristle that lines and articulates the joint, rheumatoid arthritis plaster damaged. This causes bone to rub on bone, which is painful. It allows up and down movement. The fibula bone lies on the outside of the joint.
The ankle has to bear 5 to 7 times the body weight during day to day activities, such as standing and walking. Osteoarthritis is usually secondary to damage to the joint, for example as a result of previous fracture, repeated sprains of the ankle, malalignment of the joint or infection. Excess body weight can overload a joint and worsen the symptoms of arthritis. Every extra kilogram of body weight is multiplied by 5 to 7 times when it is carried by the ankle. The alignment of the leg is such that the weight passes from the centre of the hip, through the centre of the knee, and into the centre of the ankle.
Anything which changes this alignment will alter the way the ankle is loaded and cause it to wear unevenly, and more quickly. Bow legs’ or ‘knock knees’ are examples of malalignment, which can affect the ankle. Similarly ankles which point inwards are more prone to sprains, and consequently early arthritis. In some cases realignment of the bones may be helpful in treatment.
Anyone can get ankle arthritis. Pain is the commonest and most troublesome symptom. This is usually made worse by walking. Simple ways to see if your pain is getting worse is to record whether your walking distance is decreasing, or whether you need more painkillers to ease the pain. With osteoarthritis stiffness, or reduced movement, is common. With inflammatory arthritis stiffness can often be worse first thing in the morning. There may be little pieces of loose cartilage or bone caught within the joint causing this sensation.
This may be due to looseness of the ligaments, or secondary to pain. Swelling may be as a result of extra bone, or fluid within the joint. The soft tissues can also inflame and swell. How is ankle arthritis investigated?
X-rays of the ankle are taken whilst you are standing. This simple test will give the most information on whether the ankle is worn or not. Blood tests are sometimes used to investigate inflammation, or gout. Occasionally special tests are needed to determine the extent of the arthritis, or exactly which joint is involved. An MRI scan can give a lot of information on the thickness of the cartilage lining the joint, and whether there are small areas of wear and loose cartilage. CT and bone scans may also be used to investigate ankle arthritis.
Arthroscopy can sometimes be used to washout the joint, and help in the treatment of arthritis. With any form of arthritis there are two forms of treatment. The first is without an operation, and the second is with surgery. Most arthritis can be treated without surgery, and only in severe arthritis will surgery be considered. In the first instance simple modifications of the way you lead your life should be tried. These include resting when the pain necessitates, slowing down and altering sporting activities. Weight loss, supportive boots and walking sticks are also useful.